Provider Demographics
NPI:1023614799
Name:DE GUZMAN, ERICA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DE GUZMAN
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 1:440 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1982
Mailing Address - Country:US
Mailing Address - Phone:408-209-3786
Mailing Address - Fax:
Practice Address - Street 1:1600 LOS GAMOS DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1806
Practice Address - Country:US
Practice Address - Phone:415-444-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist