Provider Demographics
NPI:1417442690
Name:RAINES, ERIKA ROCHELLE
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ROCHELLE
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RIGGINS RD APT 136
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6297
Mailing Address - Country:US
Mailing Address - Phone:305-469-2195
Mailing Address - Fax:
Practice Address - Street 1:901 RIGGINS RD APT 136
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6297
Practice Address - Country:US
Practice Address - Phone:305-469-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9153OtherSPEECH LANGUAGE PATHOLOGIST LICENSE