Provider Demographics
NPI:1801223144
Name:ERSTAD, LOIS ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ANN
Last Name:ERSTAD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16106 SW 108TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4418
Mailing Address - Country:US
Mailing Address - Phone:210-937-2636
Mailing Address - Fax:
Practice Address - Street 1:16106 SW 108TH AVE
Practice Address - Street 2:APT 1
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4418
Practice Address - Country:US
Practice Address - Phone:210-937-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist