Provider Demographics
NPI:1649413733
Name:TAO, ERICA J (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:J
Last Name:TAO
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 1:19 RYDER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3306
Mailing Address - Country:US
Mailing Address - Phone:917-363-0988
Mailing Address - Fax:
Practice Address - Street 1:281 9TH AVE
Practice Address - Street 2:P138 @33
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5701
Practice Address - Country:US
Practice Address - Phone:917-363-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01491-1235Z00000X
NY014911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist