Provider Demographics
NPI:1659005080
Name:CARLS, ERIKA LALAINE VERGARA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERIKA LALAINE
Middle Name:VERGARA
Last Name:CARLS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:VERGARA
Other - Last Name:CARLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32112 TREVOR AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7761
Mailing Address - Country:US
Mailing Address - Phone:510-566-6562
Mailing Address - Fax:
Practice Address - Street 1:210 PORTER DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1525
Practice Address - Country:US
Practice Address - Phone:925-743-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist