Provider Demographics
NPI:1801863477
Name:WHITESIDE, GERALD L (AUD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:WHITESIDE
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 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2249
Mailing Address - Country:US
Mailing Address - Phone:785-843-8479
Mailing Address - Fax:785-843-8481
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-843-8479
Practice Address - Fax:785-843-8481
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1252237600000X
KS1983231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
11839028OtherCAQH
39948015OtherBCBS OF KANSAS CITY
115852OtherBCBS OF KANSAS
KS200386610AMedicaid
KS200386610AMedicaid