Provider Demographics
NPI:1447686589
Name:WILLIS, ERIN NICOLE (MS CFY--SLP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MS CFY--SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE E-540
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-500-2401
Mailing Address - Fax:
Practice Address - Street 1:6425 W DESERT HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-3430
Practice Address - Country:US
Practice Address - Phone:602-692-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist