Healthcare Provider Details

I. General information

NPI: 1881718054
Provider Name (Legal Business Name): ERICA SPRAGUE CCC-SLP, BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

2931 E BIDDLE ST
BALTIMORE MD
21213-3939
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-16-7587
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP010161
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number08841
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: