Provider Demographics
NPI:1417518309
Name:WEBER, ERICA (MS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEBER
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 1:2852 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4928
Mailing Address - Country:US
Mailing Address - Phone:815-793-8848
Mailing Address - Fax:
Practice Address - Street 1:247 TILTON PARK DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1955
Practice Address - Country:US
Practice Address - Phone:815-739-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist