Provider Demographics
NPI:1467941880
Name:SPEAKS, ERIK DAJUAN (BS)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DAJUAN
Last Name:SPEAKS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 TAYLORSVILLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1302
Mailing Address - Country:US
Mailing Address - Phone:502-724-1711
Mailing Address - Fax:
Practice Address - Street 1:3834 TAYLORSVILLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1302
Practice Address - Country:US
Practice Address - Phone:502-724-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator