Provider Demographics
NPI:1609097815
Name:DOUGLASS, ERIN P (MED, CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:P
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MED, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MOWBRAY ARCH
Mailing Address - Street 2:#640
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-627-7734
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDREN'S LANE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-668-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist