Provider Demographics
NPI:1447712542
Name:ERICKSON-FACCA, LYNSIE
Entity type:Individual
Prefix:
First Name:LYNSIE
Middle Name:
Last Name:ERICKSON-FACCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6368 NARCISSUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-4507
Mailing Address - Country:US
Mailing Address - Phone:510-468-3574
Mailing Address - Fax:
Practice Address - Street 1:76 FENTON ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4144
Practice Address - Country:US
Practice Address - Phone:925-443-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist