Provider Demographics
NPI:1417324443
Name:HASEMAN, ERICA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HASEMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:HAWKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1066 MESSARA DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-6073
Mailing Address - Country:US
Mailing Address - Phone:303-859-2738
Mailing Address - Fax:
Practice Address - Street 1:1901 56TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2950
Practice Address - Country:US
Practice Address - Phone:970-301-4206
Practice Address - Fax:970-330-3954
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72800062Medicaid