Healthcare Provider Details

I. General information

NPI: 1790174605
Provider Name (Legal Business Name): WALTER DORRITIE MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 SAW MILL RIVER RD
YONKERS NY
10710-3210
US

IV. Provider business mailing address

17301 INTERSTATE 35 STE 101
BUDA TX
78610-5250
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-4854
  • Fax: 914-968-4857
Mailing address:
  • Phone: 512-461-3617
  • Fax: 914-968-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number114527
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP10227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: