Provider Demographics
NPI:1588870364
Name:THORSON, ERICA MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE
Last Name:THORSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-9516
Mailing Address - Country:US
Mailing Address - Phone:515-321-5922
Mailing Address - Fax:
Practice Address - Street 1:620 MEADOW CIR
Practice Address - Street 2:
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-9516
Practice Address - Country:US
Practice Address - Phone:515-321-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist