Provider Demographics
NPI:1700129590
Name:HARRISON, ERIN R (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 LAKELAND HIGHLANDS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4338
Mailing Address - Country:US
Mailing Address - Phone:863-686-3189
Mailing Address - Fax:863-682-1348
Practice Address - Street 1:3020 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4338
Practice Address - Country:US
Practice Address - Phone:863-686-3189
Practice Address - Fax:863-682-1348
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist