Provider Demographics
NPI:1093041006
Name:HERZOG, ERIN M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:HERZOG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 74TH ST
Mailing Address - Street 2:9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W 74TH ST
Practice Address - Street 2:9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2129
Practice Address - Country:US
Practice Address - Phone:415-516-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015755-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist