Provider Demographics
NPI:1801097050
Name:ANDERSON, ERICA JAYNE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:JAYNE
Last Name:ANDERSON
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 1:3178 BRIDLERUN DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-6888
Mailing Address - Country:US
Mailing Address - Phone:859-359-4080
Mailing Address - Fax:
Practice Address - Street 1:71 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3006
Practice Address - Country:US
Practice Address - Phone:859-331-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist