Provider Demographics
NPI:1457631046
Name:WHITLEY, HEATHER LEIGH (CPM, LDEM)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LEIGH
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522332
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84152-2332
Mailing Address - Country:US
Mailing Address - Phone:801-556-1483
Mailing Address - Fax:802-304-1011
Practice Address - Street 1:1174 GRAYSTONE WAY
Practice Address - Street 2:STE 2
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84152
Practice Address - Country:US
Practice Address - Phone:801-556-1483
Practice Address - Fax:802-304-1011
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0076820176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife