Provider Demographics
NPI:1871688168
Name:JARVIS, ERIN PERCEFULL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:PERCEFULL
Last Name:JARVIS
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 1:116 WARBLER RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-7529
Mailing Address - Country:US
Mailing Address - Phone:270-422-8198
Mailing Address - Fax:270-422-8197
Practice Address - Street 1:116 WARBLER RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-7529
Practice Address - Country:US
Practice Address - Phone:270-422-8198
Practice Address - Fax:270-422-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist