Healthcare Provider Details

I. General information

NPI: 1346898723
Provider Name (Legal Business Name): ERICA TRAVER M.S. ED CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 W JACKSON BLVD
CHICAGO IL
60607-2859
US

IV. Provider business mailing address

27 W 9TH ST
BAYONNE NJ
07002-2503
US

V. Phone/Fax

Practice location:
  • Phone: 551-221-6647
  • Fax:
Mailing address:
  • Phone: 551-221-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146028901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: