Provider Demographics
NPI:1205492147
Name:IERARDI, ERIN BERNADETTE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BERNADETTE
Last Name:IERARDI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:BERNADETTE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3223
Mailing Address - Country:US
Mailing Address - Phone:631-834-8472
Mailing Address - Fax:
Practice Address - Street 1:44 ELM ST STE 10
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3403
Practice Address - Country:US
Practice Address - Phone:631-425-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027970-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty