Provider Demographics
NPI:1437461456
Name:WHITAKER, RYAN MICHAEL (AUD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 EAST RIVERSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4825
Mailing Address - Country:US
Mailing Address - Phone:435-688-8991
Mailing Address - Fax:435-688-2122
Practice Address - Street 1:1054 EAST RIVERSIDE DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4825
Practice Address - Country:US
Practice Address - Phone:435-688-8991
Practice Address - Fax:435-688-2122
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7718018-4101231H00000X
UT7718018-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist