Provider Demographics
NPI:1184295537
Name:FENTON, ERICA (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:FENTON
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 1:1016 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5706
Mailing Address - Country:US
Mailing Address - Phone:630-344-9056
Mailing Address - Fax:
Practice Address - Street 1:1016 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5706
Practice Address - Country:US
Practice Address - Phone:630-344-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist