Provider Demographics
NPI:1780345009
Name:FONDU, ERICA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:FONDU
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1630
Mailing Address - Country:US
Mailing Address - Phone:203-980-2929
Mailing Address - Fax:
Practice Address - Street 1:8 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1630
Practice Address - Country:US
Practice Address - Phone:203-980-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist