Healthcare Provider Details

I. General information

NPI: 1114563202
Provider Name (Legal Business Name): DOROTHY K WHITTREDGE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 N MAIZE RD HAC
WICHITA KS
67205-7359
US

IV. Provider business mailing address

1279 ROAD 310
ALLEN KS
66833-9323
US

V. Phone/Fax

Practice location:
  • Phone: 785-409-1530
  • Fax:
Mailing address:
  • Phone: 785-409-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number677
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number503
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: