Provider Demographics
NPI:1588956353
Name:LOUISON, ERIE JACQUELINE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIE
Middle Name:JACQUELINE
Last Name:LOUISON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ERIE
Other - Middle Name:JACQUELINE
Other - Last Name:ADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:30330 OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3215
Mailing Address - Country:US
Mailing Address - Phone:305-242-9424
Mailing Address - Fax:
Practice Address - Street 1:30330 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3215
Practice Address - Country:US
Practice Address - Phone:305-242-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106385235Z00000X
NJ41YS00392600235Z00000X
FLSA12841235Z00000X
AZSLP8295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist