Provider Demographics
NPI:1982805297
Name:EGNEW, ERICA LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:EGNEW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 S MERRIMAN WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0892
Mailing Address - Country:US
Mailing Address - Phone:602-695-5688
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3054
Practice Address - Country:US
Practice Address - Phone:602-695-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6507235Z00000X
AZSLPL5016235Z00000X
AZSLP6507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist