Provider Demographics
NPI:1821358235
Name:RODGERS, ERIN CRAM (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:CRAM
Last Name:RODGERS
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 1:16019 2ND PL NE
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8494
Mailing Address - Country:US
Mailing Address - Phone:937-321-5430
Mailing Address - Fax:
Practice Address - Street 1:2445 140TH AVE NE STE B105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1879
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60121715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist