Provider Demographics
NPI:1831119973
Name:DUNNIGAN, TIMOTHY (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DUNNIGAN
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2003
Mailing Address - Country:US
Mailing Address - Phone:239-434-7000
Mailing Address - Fax:239-643-8503
Practice Address - Street 1:5470 BRYSON CT STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-434-7000
Practice Address - Fax:239-498-4172
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY673231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600049500Medicaid
FLS1346OtherBLUE CROSS &BLUE SHIELD
FLS1346AMedicare PIN