Provider Demographics
NPI:1275660300
Name:BRKOVIC, ERICA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:BRKOVIC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 IVYWILD LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9543
Mailing Address - Country:US
Mailing Address - Phone:815-462-3956
Mailing Address - Fax:
Practice Address - Street 1:3307 IVYWILD LN
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9543
Practice Address - Country:US
Practice Address - Phone:815-462-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist