Erica Ann Provost, MS, CCC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA12639 Issued in FL

Practice address

151 Terrace Shores Drive
Indialantic, FL 32903-2706

Phone

(561) 801-3264

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Erica Ann Mauser Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1770830358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 TERRACE SHORES DRIVE",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329032706",
            "telephone_number": "561-801-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 TERRACE SHORES DRIVE",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329032706",
            "telephone_number": "561-801-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "ERICA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA12639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "MAUSER",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "MS, CCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Piazza
• Maxwell Clark Poling, PA-C
• Candace Powell-Romero, DPT
• Mark Paul Preston, M.D., J.D.
• Privia Medical Group Florida, LLC
• Publix Super Markets, Inc.
• Alyssa Nicole Quixley, PT, DPT
• Joseph H. Rabinowitz, M.D.
• Vernice D Ragsdale, MD
• Chad Larsen Randol, APRN

• All providers in Indialantic, FL
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.