Provider Demographics
NPI:1629256714
Name:WHITTAKER, JANA LEE (CSW)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LEE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1818
Mailing Address - Country:US
Mailing Address - Phone:801-774-8675
Mailing Address - Fax:801-416-0862
Practice Address - Street 1:1105 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1818
Practice Address - Country:US
Practice Address - Phone:801-774-8675
Practice Address - Fax:801-416-0862
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5759113-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical