Provider Demographics
NPI:1346898723
Name:TRAVER, ERICA (MS ED SLP-CFY)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:
Last Name:TRAVER
Suffix:
Gender:F
Credentials:MS ED SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2503
Mailing Address - Country:US
Mailing Address - Phone:551-221-6647
Mailing Address - Fax:
Practice Address - Street 1:80 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1132
Practice Address - Country:US
Practice Address - Phone:551-221-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCFY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist