MEDICARE: ISABELLA WHITAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1104577022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA WHITAKER

Provider Business Mailing Address
First Line	:	4460 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3543
Country	:	US
Telephone Number	:	888-949-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 S 1470 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-4377
Country	:	US
Telephone Number	:	801-633-1358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	08/27/2024

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Directions to “ ISABELLA WHITAKER ” Practice Location

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