Provider Demographics
NPI:1790174605
Name:DORRITIE, WALTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:DORRITIE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17301 INTERSTATE 35 STE 101
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5250
Mailing Address - Country:US
Mailing Address - Phone:512-461-3617
Mailing Address - Fax:914-968-4857
Practice Address - Street 1:1154 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3210
Practice Address - Country:US
Practice Address - Phone:914-968-4854
Practice Address - Fax:914-968-4857
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114527235Z00000X
NYSLP10227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist