| Doctor Name: | ERICA MEDINE |
| NPI Number: | 1528415379 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S |
| License Number: | SP17971 |
| Business Practice Address: | 5301 Laurel Canyon Blvd Ste 245 Valley Village, CA - 916072777 |
| Business Phone Number: | 8184352960 |
| Business Fax Number: | 8184352903 |
| Mailing Address: | 13360 Burbank Blvd Apt 9, SHERMAN OAKS |
| State: | CA |
| Postal Code: | 914015384 |
| Phone Number: | 3108671145 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2016 |
| NPI Last Update Date: | 05/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP17971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |