Provider Demographics
NPI:1114365301
Name:GORHAM, ERIC JOHN
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:GORHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6202
Mailing Address - Country:US
Mailing Address - Phone:860-442-4363
Mailing Address - Fax:
Practice Address - Street 1:10 BROWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6202
Practice Address - Country:US
Practice Address - Phone:860-442-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist