Provider Demographics
NPI:1538842661
Name:PEDDY, ERICA ANN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:PEDDY
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 1:1417 SUMMERHILL DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-6049
Mailing Address - Country:US
Mailing Address - Phone:325-650-9654
Mailing Address - Fax:
Practice Address - Street 1:4213 S ROBINSON RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1408
Practice Address - Country:US
Practice Address - Phone:972-264-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant