Provider Demographics
NPI:1316252786
Name:SMITH-BOCKMIER, ERIN GABRIELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:GABRIELLE
Last Name:SMITH-BOCKMIER
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 1:3479 UNION VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-244-1272
Mailing Address - Fax:
Practice Address - Street 1:110 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-887-5591
Practice Address - Fax:814-887-5666
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019386380002Medicaid