Healthcare Provider Details

I. General information

NPI: 1104342757
Provider Name (Legal Business Name): ERICA BRODE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OLD OAK RD
RAEFORD NC
28376-6527
US

IV. Provider business mailing address

205 OLD OAK RD
RAEFORD NC
28376-6527
US

V. Phone/Fax

Practice location:
  • Phone: 480-570-1626
  • Fax:
Mailing address:
  • Phone: 480-570-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: