Provider Demographics
NPI:1821301813
Name:GOSLING, ERICA DANIELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DANIELLE
Last Name:GOSLING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:D
Other - Last Name:BIZZARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 S DUTCHER ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1604
Mailing Address - Country:US
Mailing Address - Phone:914-310-8262
Mailing Address - Fax:
Practice Address - Street 1:61 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3702
Practice Address - Country:US
Practice Address - Phone:203-977-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020485235Z00000X
CT004353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist