Healthcare Provider Details

I. General information

NPI: 1821855362
Provider Name (Legal Business Name): CAMERON ERICSON SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 W FULLER DR
ANTHEM AZ
85086-6004
US

IV. Provider business mailing address

8043 N 10TH ST
PHOENIX AZ
85020-3770
US

V. Phone/Fax

Practice location:
  • Phone: 847-596-0445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA15072
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: