Provider Demographics
NPI:1063763399
Name:ERICSON, VALERIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:ERICSON
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 1:31600 TELEGRAPH RD
Mailing Address - Street 2:STE 230
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4370
Mailing Address - Country:US
Mailing Address - Phone:248-723-9200
Mailing Address - Fax:248-723-9218
Practice Address - Street 1:3135 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-677-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14032768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5478003Medicare PIN