Provider Demographics
NPI:1699849414
Name:CARPENTER, ERICA J (MA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3896
Mailing Address - Country:US
Mailing Address - Phone:419-291-5680
Mailing Address - Fax:419-479-6158
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-5680
Practice Address - Fax:419-479-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01093231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist