Individual
DOUGLAS LYNN WHITTAKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7434 S STATE ST, MIDVALE, UT 84047-2014
(801) 566-4423
(801) 566-4779
Mailing address
4084 FOUBERT AVE, SALT LAKE CITY, UT 84124-3411
(801) 278-7453
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
126368-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107032362101
INTRMTN. HEALTH CARE
UT
01
—
827403
DESERET MUTUAL
UT
01
—
942938348003
CHAMPUS
UT
01
—
94293834BLYN
EDUCATORS MUTUAL
UT
01
—
R88031
MEDICARE ADVANAGE PLANS
UT
Enumeration date
12/20/2005
Last updated
07/08/2007
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