MEDICARE: MRS. ERIKA MICHELE MOORMAN M.S.,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA7285	FL

General Provider Information

NPI Number	:	1609475094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIKA MICHELE MOORMAN M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	913 SW 19TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1925
Country	:	US
Telephone Number	:	954-261-0126
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 SEMINOLE DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3243
Country	:	US
Telephone Number	:	954-504-9315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2020
Last Update Date	:	10/18/2020

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