Provider Demographics
NPI:1558601237
Name:BECERRA, ERIN B (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:B
Last Name:BECERRA
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 1:1455 BICKER CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5728
Mailing Address - Country:US
Mailing Address - Phone:949-230-7781
Mailing Address - Fax:949-230-7781
Practice Address - Street 1:3498 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672-9625
Practice Address - Country:US
Practice Address - Phone:530-391-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist