Provider Demographics
NPI:1922237973
Name:BRACKIN, ERIN T
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:T
Last Name:BRACKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 W ROBINO DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 REED RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3505
Practice Address - Country:US
Practice Address - Phone:610-356-1991
Practice Address - Fax:610-356-2011
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000265235Z00000X
PASL010613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist