Provider Demographics
NPI:1700350220
Name:FERGUSON, ERICA ELAINE (HAD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ELAINE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 COLONEL GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6248
Mailing Address - Country:US
Mailing Address - Phone:937-426-2434
Mailing Address - Fax:
Practice Address - Street 1:2602 COLONEL GLENN HWY
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-6248
Practice Address - Country:US
Practice Address - Phone:937-426-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02951237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist