Provider Demographics
NPI:1427345941
Name:WITTKOPP, ANN (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WITTKOPP
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4896
Mailing Address - Country:US
Mailing Address - Phone:509-899-6500
Mailing Address - Fax:
Practice Address - Street 1:291 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4896
Practice Address - Country:US
Practice Address - Phone:509-899-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND751-172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer