Individual
ERICA MOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 W DAKOTA PKWY, WILLISTON, ND 58801-3885
(701) 572-6757
Mailing address
PO BOX 2397, WILLISTON, ND 58802-2397
(701) 572-6757
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1023
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023
STATE LICENSE
ND
05
—
52388
—
ND
Enumeration date
03/03/2009
Last updated
03/03/2009
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