Provider Demographics
NPI:1669844635
Name:LAVIGNE, ERICA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1200 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1851
Mailing Address - Country:US
Mailing Address - Phone:402-944-7083
Mailing Address - Fax:
Practice Address - Street 1:1200 BOYD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1851
Practice Address - Country:US
Practice Address - Phone:402-944-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist