Provider Demographics
NPI:1184106312
Name:BODOIN, ERIKA MELISSA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:MELISSA
Last Name:BODOIN
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 1:1005 GREAT BRITAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6459
Mailing Address - Country:US
Mailing Address - Phone:512-294-9077
Mailing Address - Fax:
Practice Address - Street 1:1005 GREAT BRITAIN BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6459
Practice Address - Country:US
Practice Address - Phone:512-294-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist