Provider Demographics
NPI:1669997789
Name:CUNNINGHAM, ERIN BROOKE (SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:BROOKE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:BROOKE
Other - Last Name:THEVENIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:710 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2502
Mailing Address - Country:US
Mailing Address - Phone:304-546-3765
Mailing Address - Fax:
Practice Address - Street 1:710 OAK ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-2502
Practice Address - Country:US
Practice Address - Phone:304-546-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1883235Z00000X
WV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist