Provider Demographics
NPI:1427388818
Name:WITTENAUER, EMILY ANN
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:WITTENAUER
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 1:2306 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5026
Mailing Address - Country:US
Mailing Address - Phone:618-977-5216
Mailing Address - Fax:
Practice Address - Street 1:2306 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5026
Practice Address - Country:US
Practice Address - Phone:618-977-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist