Provider Demographics
NPI:1194041939
Name:DITTMER, VALERI KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VALERI
Middle Name:KAY
Last Name:DITTMER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E COUNTY ROAD 1950
Mailing Address - Street 2:
Mailing Address - City:BURNSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:62330-5335
Mailing Address - Country:US
Mailing Address - Phone:217-357-1139
Mailing Address - Fax:
Practice Address - Street 1:2330 E COUNTY ROAD 1950
Practice Address - Street 2:
Practice Address - City:BURNSIDE
Practice Address - State:IL
Practice Address - Zip Code:62330-5335
Practice Address - Country:US
Practice Address - Phone:217-357-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist