Healthcare Provider Details

I. General information

NPI: 1356466171
Provider Name (Legal Business Name): ERICA M CALDWELL MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

IV. Provider business mailing address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9528
  • Fax: 870-933-9778
Mailing address:
  • Phone: 870-933-9528
  • Fax: 870-933-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1859
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: