Provider Demographics
NPI:1124241799
Name:ETTINGER, DONNA PROCTOR (MED, CCC-A)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:PROCTOR
Last Name:ETTINGER
Suffix:
Gender:F
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LOUISE
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-A
Mailing Address - Street 1:15608 PEYTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1682
Mailing Address - Country:US
Mailing Address - Phone:301-390-0520
Mailing Address - Fax:
Practice Address - Street 1:8350 RICHMOND HWY
Practice Address - Street 2:SUITE 233
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2300
Practice Address - Country:US
Practice Address - Phone:703-704-6159
Practice Address - Fax:703-704-6671
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000229231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist