Provider Demographics
NPI:1487283677
Name:STOVALL, ERIN CALLIE (MS, ATC, CES)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:CALLIE
Last Name:STOVALL
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FRIDA KAHLO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1822
Mailing Address - Country:US
Mailing Address - Phone:415-586-8200
Mailing Address - Fax:
Practice Address - Street 1:175 FRIDA KAHLO WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1822
Practice Address - Country:US
Practice Address - Phone:415-586-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000166222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer