Provider Demographics
NPI:1710123898
Name:ERCOLINE, SIMONE ALTHEA (MS ED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:ALTHEA
Last Name:ERCOLINE
Suffix:
Gender:F
Credentials:MS ED CCC-SLP
Other - Prefix:MISS
Other - First Name:SIMONE
Other - Middle Name:ALTHEA
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED CCC-SLP
Mailing Address - Street 1:223 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4425
Mailing Address - Country:US
Mailing Address - Phone:914-388-5216
Mailing Address - Fax:
Practice Address - Street 1:VALLEY CENTRAL SCHOOL DISTRICT
Practice Address - Street 2:944 STATE ROUTE 17K
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549
Practice Address - Country:US
Practice Address - Phone:845-457-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018787-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist