Provider Demographics
NPI:1467727966
Name:IGO, ERICKA KAYLN
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:KAYLN
Last Name:IGO
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 1:8885 W THUNDERBIRD RD
Mailing Address - Street 2:APT. 2031
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3648
Mailing Address - Country:US
Mailing Address - Phone:623-910-8137
Mailing Address - Fax:
Practice Address - Street 1:352 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1646
Practice Address - Country:US
Practice Address - Phone:602-212-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA76852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant