Provider Demographics
NPI:1841574134
Name:LEAL, ERICA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 NE LOOP 410 STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5211
Mailing Address - Country:US
Mailing Address - Phone:210-829-5777
Mailing Address - Fax:210-829-5777
Practice Address - Street 1:1804 NE LOOP 410 STE 220
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5211
Practice Address - Country:US
Practice Address - Phone:210-829-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159438402Medicaid