Provider Demographics
NPI:1922686864
Name:KOCHIS, ERICA BRET (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BRET
Last Name:KOCHIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PINE SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6187
Mailing Address - Country:US
Mailing Address - Phone:386-689-9272
Mailing Address - Fax:
Practice Address - Street 1:140 WALLACE RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8069
Practice Address - Country:US
Practice Address - Phone:386-427-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1425507235Z00000X
FLSA19016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist