Provider Demographics
NPI:1679504005
Name:WORTHINGTON, DON W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:W
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SOUTH 500 EAST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2700
Mailing Address - Country:US
Mailing Address - Phone:801-595-1700
Mailing Address - Fax:801-539-8900
Practice Address - Street 1:230 SOUTH 500 EAST
Practice Address - Street 2:SUITE 150
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2700
Practice Address - Country:US
Practice Address - Phone:801-595-1700
Practice Address - Fax:801-539-8900
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT271474-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0343Medicaid
UT11404Medicare ID - Type UnspecifiedAUDIOLOGIST