Provider Demographics
NPI:1982104311
Name:COOK, ERICCA NICOLE (CCC-SLPT)
Entity Type:Individual
Prefix:
First Name:ERICCA
Middle Name:NICOLE
Last Name:COOK
Suffix:
Gender:F
Credentials:CCC-SLPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 11TH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3566
Mailing Address - Country:US
Mailing Address - Phone:909-792-0543
Mailing Address - Fax:
Practice Address - Street 1:112 11TH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3566
Practice Address - Country:US
Practice Address - Phone:909-792-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist