Provider Demographics
NPI:1679124309
Name:ERICKSON, SARA ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2410
Mailing Address - Country:US
Mailing Address - Phone:319-572-4155
Mailing Address - Fax:
Practice Address - Street 1:SOUTHEAST AREA COOPERATIVE
Practice Address - Street 2:1109 W CEDAR ST
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004
Practice Address - Country:US
Practice Address - Phone:605-763-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist