Provider Demographics
NPI:1417382276
Name:WHITTENBURG, CHERISH ANN
Entity Type:Individual
Prefix:
First Name:CHERISH
Middle Name:ANN
Last Name:WHITTENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2001
Mailing Address - Country:US
Mailing Address - Phone:941-355-7637
Mailing Address - Fax:
Practice Address - Street 1:350 BRADEN AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2001
Practice Address - Country:US
Practice Address - Phone:941-355-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9512227464171W00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171W00000XOther Service ProvidersContractor