Provider Demographics
NPI:1154363018
Name:HALLIS, ERICKA ELLEN (AUD)
Entity type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:ELLEN
Last Name:HALLIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:AUDIOLOGY/SPEECH (126)
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:910-822-7983
Mailing Address - Fax:910-822-7088
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:AUDIOLOGY/SPEECH(126)
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-822-7983
Practice Address - Fax:910-822-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5647231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413098Medicaid
NC7413098Medicaid