Provider Demographics
NPI:1518479393
Name:SELBST, ERICA LAUREN (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LAUREN
Last Name:SELBST
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SE 2ND AVE UNIT 501
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3627
Mailing Address - Country:US
Mailing Address - Phone:954-257-2723
Mailing Address - Fax:
Practice Address - Street 1:32 SE 2ND AVE UNIT 501
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3627
Practice Address - Country:US
Practice Address - Phone:954-257-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist