Provider Demographics
NPI:1528232857
Name:CUNNINGHAM, ERICA (MA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2408
Mailing Address - Country:US
Mailing Address - Phone:610-202-6801
Mailing Address - Fax:
Practice Address - Street 1:550 17TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5789
Practice Address - Country:US
Practice Address - Phone:206-320-3494
Practice Address - Fax:206-386-2845
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60478460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020413460001Medicaid