Provider Demographics
NPI:1598432007
Name:ERICKSON, ANNA SPENCER
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:SPENCER
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1568
Mailing Address - Country:US
Mailing Address - Phone:314-246-0196
Mailing Address - Fax:314-227-9326
Practice Address - Street 1:9450 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1568
Practice Address - Country:US
Practice Address - Phone:314-246-0196
Practice Address - Fax:314-227-9326
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023039225235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty