MEDICARE: ERICA JOY MS CCC-SLP

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

General Provider Information

NPI Number	:	1205164308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA JOY MS CCC-SLP

Provider Business Mailing Address
First Line	:	5370 SAINT LEONARD RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-2557
Country	:	US
Telephone Number	:	443-550-9760
Fax Number	:	410-286-4022

Provider Business Practice Location Address
First Line	:	5370 SAINT LEONARD RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-2557
Country	:	US
Telephone Number	:	443-550-9760
Fax Number	:	410-286-4022

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

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	10/07/2021

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