Healthcare Provider Details

I. General information

NPI: 1184178337
Provider Name (Legal Business Name): ERIN ELIZABETH EBERT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 ENTERPRISE RD
ORANGE CITY FL
32763-8217
US

IV. Provider business mailing address

736 W FLORENCE AVE
DELAND FL
32720-3205
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax: 877-399-5578
Mailing address:
  • Phone: 386-748-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: