Provider Demographics
NPI:1003249921
Name:ERKKILA, PHILLIP MICAN (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICAN
Last Name:ERKKILA
Suffix:
Gender:M
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-6601
Mailing Address - Country:US
Mailing Address - Phone:906-396-1764
Mailing Address - Fax:
Practice Address - Street 1:950 PENINSULA CORPORATE CIR
Practice Address - Street 2:SUITE 1014
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1378
Practice Address - Country:US
Practice Address - Phone:561-994-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 6209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist