Provider Demographics
NPI:1710204110
Name:CARLSON, ERIN MELISSA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MELISSA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MELISSA
Other - Last Name:DUBRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:4100 E MISSISSIPPI AVE STE 1250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3047
Mailing Address - Country:US
Mailing Address - Phone:303-749-0422
Mailing Address - Fax:
Practice Address - Street 1:40 BUMBLEBEE LN
Practice Address - Street 2:
Practice Address - City:NORTH LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:12967-9566
Practice Address - Country:US
Practice Address - Phone:518-572-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist