1124241799 NPI number — DONNA PROCTOR ETTINGER M.ED., CCC-A

Table of content: DONNA PROCTOR ETTINGER M.ED., CCC-A (NPI 1124241799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124241799 NPI number — DONNA PROCTOR ETTINGER M.ED., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETTINGER
Provider First Name:
DONNA
Provider Middle Name:
PROCTOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROCTOR
Provider Other First Name:
DONNA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124241799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15608 PEYTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20716-1682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-390-0520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8350 RICHMOND HWY
Provider Second Line Business Practice Location Address:
SUITE 233
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22309-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-704-6159
Provider Business Practice Location Address Fax Number:
703-704-6671
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  2201000229 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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