Provider Demographics
NPI:1023522919
Name:GERTEISEN, RITA A
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:A
Last Name:GERTEISEN
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:OWENSBORO HEALTH SPEECH AND AUDIOLOGY
Mailing Address - Street 2:2211 MAYFAIR DRIVE, SUITE 402
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-688-6140
Mailing Address - Fax:270-417-0140
Practice Address - Street 1:2211 MAYFAIR DR STE 402
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4570
Practice Address - Country:US
Practice Address - Phone:270-688-6140
Practice Address - Fax:270-417-0140
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100226231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist