Healthcare Provider Details

I. General information

NPI: 1891949608
Provider Name (Legal Business Name): ERIN NICOLE GEPHARD MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WESTERN AVE
MARLBORO NY
12542-5121
US

IV. Provider business mailing address

123 WESTERN AVE
MARLBORO NY
12542-5121
US

V. Phone/Fax

Practice location:
  • Phone: 845-236-1212
  • Fax:
Mailing address:
  • Phone: 845-236-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012522-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: