Provider Demographics
NPI:1144253147
Name:DITTENHOEFER, JOYCE FRALEIGH (AUD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:FRALEIGH
Last Name:DITTENHOEFER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SOUTH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4818
Mailing Address - Country:US
Mailing Address - Phone:845-485-0179
Mailing Address - Fax:845-485-0187
Practice Address - Street 1:205 SOUTH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4818
Practice Address - Country:US
Practice Address - Phone:845-485-0179
Practice Address - Fax:845-485-0187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001868-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP61898Medicare UPIN
NYM71671Medicare ID - Type Unspecified