Provider Demographics
NPI:1710956461
Name:SCALES, ERICA (MCD CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3513
Mailing Address - Country:US
Mailing Address - Phone:912-655-6007
Mailing Address - Fax:
Practice Address - Street 1:421 E 54TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3513
Practice Address - Country:US
Practice Address - Phone:912-655-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0004835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10046716OtherAMERIGROUP
GA52704304OtherBLUE CROSS BLUE SHIELF OF GEORGIA PAR AND PPO
GA340992OtherWELLCARE
GA000902173AMedicaid