Provider Demographics
NPI:1194051516
Name:GARCIA, ERICA LEE (SLP)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CFY-SLP
Mailing Address - Street 1:5322 SARATOGA BLVD.
Mailing Address - Street 2:APT. 122
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2397
Mailing Address - Country:US
Mailing Address - Phone:361-228-3503
Mailing Address - Fax:
Practice Address - Street 1:5633 S. STAPLES STREET
Practice Address - Street 2:SUITE 400 & 500
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4646
Practice Address - Country:US
Practice Address - Phone:361-855-1352
Practice Address - Fax:361-855-1254
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215580601Medicaid