Provider Demographics
NPI:1144383894
Name:WITMER, TRISHA R (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:R
Last Name:WITMER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7063
Mailing Address - Country:US
Mailing Address - Phone:952-233-5370
Mailing Address - Fax:267-287-9549
Practice Address - Street 1:327 MARSCHALL RD STE 390
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1700
Practice Address - Country:US
Practice Address - Phone:612-807-3723
Practice Address - Fax:267-287-9549
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist