Provider Demographics
NPI:1770829426
Name:KABU, ERIKA LAIBSON
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LAIBSON
Last Name:KABU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WILLIVEE DR
Mailing Address - Street 2:DECATUR
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4131
Mailing Address - Country:US
Mailing Address - Phone:404-664-1304
Mailing Address - Fax:
Practice Address - Street 1:3300 MEMORIAL DR
Practice Address - Street 2:SUITE D4/D5
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2700
Practice Address - Country:US
Practice Address - Phone:404-289-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist