Provider Demographics
NPI:1700823630
Name:EHRITT, DONELLE (MA)
Entity Type:Individual
Prefix:
First Name:DONELLE
Middle Name:
Last Name:EHRITT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 SCOTTS VALLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3524
Mailing Address - Country:US
Mailing Address - Phone:831-431-6216
Mailing Address - Fax:831-431-6216
Practice Address - Street 1:5321 SCOTTS VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3524
Practice Address - Country:US
Practice Address - Phone:831-431-6216
Practice Address - Fax:831-431-6216
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU46231H00000X
CAHA1110237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0000460Medicaid