Provider Demographics
NPI:1225314529
Name:MATTICE, ERICA GRACE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:GRACE
Last Name:MATTICE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1703
Mailing Address - Country:US
Mailing Address - Phone:518-773-3741
Mailing Address - Fax:
Practice Address - Street 1:2755 STATE HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3747
Practice Address - Country:US
Practice Address - Phone:518-736-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist