MEDICARE: MRS. LISA NICOLE ERWIN-DAVIDSON M.S., CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		VT

General Provider Information

NPI Number	:	1184818296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA NICOLE ERWIN-DAVIDSON M.S., CCC

Provider Business Mailing Address
First Line	:	81 MEDICAL VILLAGE DR
Second Line	:	NORTH COUNTRY HEALTH SYSTEM
City	:	NEWPORT
State	:	VT
Zip	:	05855-9897
Country	:	US
Telephone Number	:	802-334-3260
Fax Number	:	802-334-4163

Provider Business Practice Location Address
First Line	:	81 MEDICAL VILLAGE DR
Second Line	:	NORTH COUNTRY HEALTH SYSTEM
City	:	NEWPORT
State	:	VT
Zip	:	05855-9897
Country	:	US
Telephone Number	:	802-334-3260
Fax Number	:	802-334-4163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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