Provider Demographics
NPI:1982937769
Name:SHUPTAR, ERICKA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:A
Last Name:SHUPTAR
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 1:305 MURPHY CIR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4706
Mailing Address - Country:US
Mailing Address - Phone:248-504-9530
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD STE 2H
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-220-4974
Practice Address - Fax:517-220-4974
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist