Provider Demographics
NPI:1689472300
Name:GRITZER, CARLIE RAE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:RAE
Last Name:GRITZER
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:RAE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 ICE PLANT RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-7573
Mailing Address - Country:US
Mailing Address - Phone:814-590-9365
Mailing Address - Fax:
Practice Address - Street 1:239 ICE PLANT RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-7573
Practice Address - Country:US
Practice Address - Phone:814-590-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist