Provider Demographics
NPI:1871873760
Name:KAGAN, ERIN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 WEBSTER ST
Practice Address - Street 2:APT 407
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4998
Practice Address - Country:US
Practice Address - Phone:305-632-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10800235Z00000X
MA8175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist