Provider Demographics
NPI:1821231903
Name:WALSH, ERIN (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WALSH
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 1:429 CROSS BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1025
Mailing Address - Country:US
Mailing Address - Phone:718-318-2330
Mailing Address - Fax:
Practice Address - Street 1:429 CROSS BAY BLVD
Practice Address - Street 2:
Practice Address - City:BROAD CHANNEL
Practice Address - State:NY
Practice Address - Zip Code:11693-1025
Practice Address - Country:US
Practice Address - Phone:718-318-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-11112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist