Provider Demographics
NPI:1689041089
Name:NICHOLAS, ERICA GRACE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:GRACE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:GRACE
Other - Last Name:MADAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9606 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6501
Mailing Address - Country:US
Mailing Address - Phone:858-695-9415
Mailing Address - Fax:858-695-9412
Practice Address - Street 1:9606 TIERRA GRANDE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6501
Practice Address - Country:US
Practice Address - Phone:858-695-9415
Practice Address - Fax:858-695-9412
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP23297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist