Provider Demographics
NPI:1710347927
Name:FLORES, ERICA (MT-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1675
Mailing Address - Country:US
Mailing Address - Phone:262-327-1120
Mailing Address - Fax:
Practice Address - Street 1:2314 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1675
Practice Address - Country:US
Practice Address - Phone:262-327-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI07911225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist