Provider Demographics
NPI:1831713049
Name:WHITTAKER, DANE BRADFORD (AUD)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:BRADFORD
Last Name:WHITTAKER
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 1:617 E RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8721
Mailing Address - Country:US
Mailing Address - Phone:435-628-3334
Mailing Address - Fax:
Practice Address - Street 1:617 E RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8721
Practice Address - Country:US
Practice Address - Phone:435-628-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8391810-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist