Doctor Name: | MRS. ANN GOGENOLA ERICKSON |
NPI Number: | 1528379724 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCCSLP |
License Number: | 013096 |
Business Practice Address: | 930 Gara Pl Astoria, OR - 971035720 |
Business Phone Number: | 5034400802 |
Business Fax Number: | |
Mailing Address: | 930 Gara Pl, ASTORIA |
State: | OR |
Postal Code: | 971035720 |
Phone Number: | 5034400802 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2010 |
NPI Last Update Date: | 06/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 013096 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |