Provider Demographics
NPI:1609346592
Name:HEITKAMP, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HEITKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2096 COUNTY ROAD 24 S
Mailing Address - Street 2:
Mailing Address - City:DE GRAFF
Mailing Address - State:OH
Mailing Address - Zip Code:43318-9406
Mailing Address - Country:US
Mailing Address - Phone:937-585-5981
Mailing Address - Fax:
Practice Address - Street 1:2096 COUNTY ROAD 24 S
Practice Address - Street 2:
Practice Address - City:DE GRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318-9406
Practice Address - Country:US
Practice Address - Phone:937-585-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OHSP.11557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist