Provider Demographics
NPI:1043719974
Name:BOCCARDO, ERIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOCCARDO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10855 GAMBRIL DR APT 11
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6583
Mailing Address - Country:US
Mailing Address - Phone:609-571-7099
Mailing Address - Fax:
Practice Address - Street 1:9075 PARK AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4317
Practice Address - Country:US
Practice Address - Phone:571-377-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist