Provider Demographics
NPI:1750631719
Name:DITTRICH, LORETTA ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ELIZABETH
Last Name:DITTRICH
Suffix:
Gender:F
Credentials: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:PO BOX 576649
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6649
Mailing Address - Country:US
Mailing Address - Phone:209-571-8330
Mailing Address - Fax:209-491-7184
Practice Address - Street 1:1809 SAVOIE WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8947
Practice Address - Country:US
Practice Address - Phone:209-679-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 7919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist