Provider Demographics
NPI:1508436726
Name:WANG, ERIN (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SILLS RD
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980
Mailing Address - Country:US
Mailing Address - Phone:631-924-5583
Mailing Address - Fax:
Practice Address - Street 1:430 SILLS RD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980
Practice Address - Country:US
Practice Address - Phone:631-924-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist