Provider Demographics
NPI:1568769479
Name:HASKINS, ERIN BRANTLEY (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BRANTLEY
Last Name:HASKINS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:REBECCA
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:3256 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1778
Mailing Address - Country:US
Mailing Address - Phone:229-560-6944
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:3256 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1778
Practice Address - Country:US
Practice Address - Phone:229-560-6944
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107600DMedicaid
GASLP007239OtherSLP LICENSE
GA003107600CMedicaid
GA003107600EMedicaid
GA003107600DMedicaid