Provider Demographics
NPI:1295392678
Name:GITELIS, ERYN
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:GITELIS
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 1:4170 ADMIRALTY WAY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6217
Mailing Address - Country:US
Mailing Address - Phone:847-826-9047
Mailing Address - Fax:
Practice Address - Street 1:4170 ADMIRALTY WAY UNIT 105
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6217
Practice Address - Country:US
Practice Address - Phone:847-826-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist