Erica Smith
Individual provider Active NPI Speech-Language Pathologist · Capron, IL
NPI 1104430438 · NPPES record last updated Nov 11, 2024
Key facts
- NPI
- 1104430438
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 242.005809 (IL)
- Practice address
- 200 N Wooster St
Capron, IL 61012-9550 - Phone
- (815) 608-3776
- NPI assigned
- Sep 3, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242.005809 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Speech-Language Pathologist | 235Z00000X | 242.005809 | IL | Yes |
Addresses
Primary practice location
200 N Wooster St
Capron, IL 61012-9550
Mailing address
200 N Wooster St
Capron, IL 61012-9550
Other providers in Capron, IL
All providers in Capron, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.