Provider Demographics
NPI:1831329556
Name:WITTERT, ALAN ARTHUR (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:ARTHUR
Last Name:WITTERT
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 5TH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2454
Mailing Address - Country:US
Mailing Address - Phone:310-392-4916
Mailing Address - Fax:
Practice Address - Street 1:2302 5TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2454
Practice Address - Country:US
Practice Address - Phone:310-392-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist