Provider Demographics
NPI:1811290984
Name:SCAMMACCA, ERICA MULLEN (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MULLEN
Last Name:SCAMMACCA
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8396 ODIS YARBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SAINT MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-2757
Mailing Address - Country:US
Mailing Address - Phone:904-653-1991
Mailing Address - Fax:
Practice Address - Street 1:8396 ODIS YARBOROUGH RD
Practice Address - Street 2:
Practice Address - City:GLEN SAINT MARY
Practice Address - State:FL
Practice Address - Zip Code:32040-2757
Practice Address - Country:US
Practice Address - Phone:904-653-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist