Individual
EMILY ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
616 W 3000 S, DRIGGS, ID 83422-8342
(307) 349-4332
Mailing address
PO BOX 1676, DRIGGS, ID 83422-1803
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14082738
—
235Z00000X
Speech-Language Pathologist
SLP-3036
ID
235Z00000X
Speech-Language Pathologist
SP-873
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366818494
—
ID
01
—
14082738
NATIONAL CERTIFICATION
—
01
—
SLP-3036
STATE LICENSE
ID
01
—
SP-873
STATE LICENSE
WY
Enumeration date
08/12/2015
Last updated
10/26/2018
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