Provider Demographics
NPI:1639454564
Name:TUCK, ERIN K (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:K
Last Name:TUCK
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 1:100 MERRIMAC CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8185
Mailing Address - Country:US
Mailing Address - Phone:859-779-1106
Mailing Address - Fax:
Practice Address - Street 1:100 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8185
Practice Address - Country:US
Practice Address - Phone:859-779-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist