Provider Demographics
NPI:1528415379
Name:MEDINE, ERICA (MS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MEDINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 BURBANK BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5384
Mailing Address - Country:US
Mailing Address - Phone:310-867-1145
Mailing Address - Fax:
Practice Address - Street 1:5301 LAUREL CANYON BLVD STE 245
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2777
Practice Address - Country:US
Practice Address - Phone:818-435-2960
Practice Address - Fax:818-435-2903
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist