Provider Demographics
NPI:1184818296
Name:ERWIN-DAVIDSON, LISA NICOLE (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:ERWIN-DAVIDSON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL VILLAGE DR
Mailing Address - Street 2:NORTH COUNTRY HEALTH SYSTEM
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9897
Mailing Address - Country:US
Mailing Address - Phone:802-334-3260
Mailing Address - Fax:802-334-4163
Practice Address - Street 1:81 MEDICAL VILLAGE DR
Practice Address - Street 2:NORTH COUNTRY HEALTH SYSTEM
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9897
Practice Address - Country:US
Practice Address - Phone:802-334-3260
Practice Address - Fax:802-334-4163
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist