Provider Demographics
NPI:1073994414
Name:PETTY, ERICA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:DEVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:27074 ROSE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27074 ROSE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5464
Practice Address - Country:US
Practice Address - Phone:814-270-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 10409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist