Provider Demographics
NPI:1225170913
Name:LEVENTHAL, ERIN JACARUSO (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JACARUSO
Last Name:LEVENTHAL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CAROLINA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6000
Mailing Address - Country:US
Mailing Address - Phone:336-370-4070
Mailing Address - Fax:336-370-9008
Practice Address - Street 1:1313 CAROLINA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6000
Practice Address - Country:US
Practice Address - Phone:336-370-4070
Practice Address - Fax:336-370-9008
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412056Medicaid
NC135HROtherBCBS
NC186373OtherMEDCOST