Provider Demographics
NPI:1689965824
Name:HARALDSEN, ERICA D (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:HARALDSEN
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 1:135 ELM ST APT A
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2667
Mailing Address - Country:US
Mailing Address - Phone:508-917-8588
Mailing Address - Fax:
Practice Address - Street 1:107 OTIS ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2459
Practice Address - Country:US
Practice Address - Phone:508-898-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist