Provider Demographics
NPI:1356788012
Name:OSBORNE, ERICA YOLANDA (MA/CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:YOLANDA
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13016 EASTFIELD RD
Mailing Address - Street 2:STE 200-336
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6622
Mailing Address - Country:US
Mailing Address - Phone:704-274-9062
Mailing Address - Fax:866-268-3797
Practice Address - Street 1:13016 EASTFIELD RD
Practice Address - Street 2:STE 200-336
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6622
Practice Address - Country:US
Practice Address - Phone:704-274-9062
Practice Address - Fax:866-268-3797
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412127Medicaid