Provider Demographics
NPI:1164677316
Name:SHAW, ERICA K (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:K
Last Name:SHAW
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 1:19 STEBBINS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1411
Mailing Address - Country:US
Mailing Address - Phone:315-853-3235
Mailing Address - Fax:
Practice Address - Street 1:3 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5643
Practice Address - Country:US
Practice Address - Phone:315-724-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016176-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist