Provider Demographics
NPI:1437589330
Name:VITALIANO, ERICA LILYANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LILYANN
Last Name:VITALIANO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MULTREES XING UNIT 306
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6996
Mailing Address - Country:US
Mailing Address - Phone:847-609-5100
Mailing Address - Fax:
Practice Address - Street 1:2101 MULTREES XING UNIT 306
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6996
Practice Address - Country:US
Practice Address - Phone:847-609-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1460127474235Z00000X
FLSA17969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist