Provider Demographics
NPI:1265670988
Name:TUCKER, ERICKA ILENE (MSCCC-A)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:ILENE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2140
Mailing Address - Country:US
Mailing Address - Phone:678-825-2469
Mailing Address - Fax:
Practice Address - Street 1:2365 OLD MILTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2140
Practice Address - Country:US
Practice Address - Phone:678-825-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2537231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist