Provider Demographics
NPI:1730950643
Name:WHITTAKER, AUTUMN NICOLE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2379
Mailing Address - Country:US
Mailing Address - Phone:720-964-0688
Mailing Address - Fax:
Practice Address - Street 1:630 PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2379
Practice Address - Country:US
Practice Address - Phone:720-964-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13613943-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst