Provider Demographics
NPI:1215589106
Name:WHITAKER, BRANDON (HTP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:HTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7141
Mailing Address - Country:US
Mailing Address - Phone:843-766-0871
Mailing Address - Fax:
Practice Address - Street 1:712 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7141
Practice Address - Country:US
Practice Address - Phone:843-766-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTP1060235500000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHTP1060OtherDHEC