Provider Demographics
NPI:1306469697
Name:DOUGHERTY, ERIKA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:DOUGHERTY
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 1:8314 MILE TREE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4317
Mailing Address - Country:US
Mailing Address - Phone:903-908-1950
Mailing Address - Fax:
Practice Address - Street 1:8314 MILE TREE DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4317
Practice Address - Country:US
Practice Address - Phone:903-908-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-03-29
Deactivation Date:2020-06-26
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
AR201512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist