Healthcare Provider Details

I. General information

NPI: 1134047392
Provider Name (Legal Business Name): CAROL A DITTOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 S UNION RD
DAYTON OH
45417-5535
US

IV. Provider business mailing address

1627 MAYO AVE
KETTERING OH
45409-2022
US

V. Phone/Fax

Practice location:
  • Phone: 937-835-5682
  • Fax:
Mailing address:
  • Phone: 937-602-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-03223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: