Provider Demographics
NPI:1689366957
Name:WHITAKER, NAOMI ANN
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:ANN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NAOMI
Other - Middle Name:ANN
Other - Last Name:UNGRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9314 RYDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6823
Practice Address - Country:US
Practice Address - Phone:325-261-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician