Provider Demographics
NPI:1548397169
Name:RITCHIE, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RITCHIE
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 1:3900 MAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7227
Mailing Address - Country:US
Mailing Address - Phone:310-295-7799
Mailing Address - Fax:818-716-7224
Practice Address - Street 1:1141 W REDONDO BEACH BLVD STE 402
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3582
Practice Address - Country:US
Practice Address - Phone:310-329-8633
Practice Address - Fax:310-329-8636
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2248237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0022480Medicaid
CAAU0022480Medicaid