Provider Demographics
NPI:1790109353
Name:MOECKEL, ERICA WALKER (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:WALKER
Last Name:MOECKEL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LEXINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9029
Mailing Address - Country:US
Mailing Address - Phone:407-454-2087
Mailing Address - Fax:
Practice Address - Street 1:225 LEXINGDALE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9029
Practice Address - Country:US
Practice Address - Phone:407-454-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist