Provider Demographics
NPI:1083400493
Name:NEWMAN, ERICA DANIELLE (DI)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:NEWMAN
Suffix:
Gender:
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:DRAKESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42337-0475
Mailing Address - Country:US
Mailing Address - Phone:270-280-7249
Mailing Address - Fax:
Practice Address - Street 1:130 W MOSE RAGER BLVD
Practice Address - Street 2:
Practice Address - City:DRAKESBORO
Practice Address - State:KY
Practice Address - Zip Code:42337-2113
Practice Address - Country:US
Practice Address - Phone:270-280-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY358192222Q00000X
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist