Provider Demographics
NPI:1891139267
Name:SANFORD, ERICA JANE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:SANFORD
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 1:2201 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1619
Mailing Address - Country:US
Mailing Address - Phone:808-292-1119
Mailing Address - Fax:
Practice Address - Street 1:1864 WELCHWOOD CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5532
Practice Address - Country:US
Practice Address - Phone:808-292-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14046426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist