Provider Demographics
NPI:1265945315
Name:ANDERSON, ERIN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:ANDERSON
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 1:1001 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S CHAMPAIGN ST
Practice Address - Street 2:
Practice Address - City:BEMENT
Practice Address - State:IL
Practice Address - Zip Code:61813-1512
Practice Address - Country:US
Practice Address - Phone:217-678-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-12
Last Update Date:2017-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist