Provider Demographics
NPI:1295384360
Name:DITZLER, MINDY SUE (LBS, MA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:DITZLER
Suffix:
Gender:F
Credentials:LBS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 ROHRERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2322
Mailing Address - Country:US
Mailing Address - Phone:717-735-1920
Mailing Address - Fax:
Practice Address - Street 1:1886 ROHRERSTOWN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2322
Practice Address - Country:US
Practice Address - Phone:717-735-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PABH004453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst