Basic Information
| Provider Information | |||||||||
| NPI: | 1134548183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERTTER | ||||||||
| FirstName: | KARLEE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19110 MONTGOMERY VILLAGE AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY VILLAGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208863706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019776317 | ||||||||
| FaxNumber: | 3019778503 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 OLD COURT RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | PIKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212082894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105801222 | ||||||||
| FaxNumber: | 4105809114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/13/2018 | ||||||||
| NPIReactivationDate: | 08/22/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 01465 | MD | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 381008900 | 05 | MD | MEDICAID |