Basic Information
| Provider Information | |||||||||
| NPI: | 1447712542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERICKSON-FACCA | ||||||||
| FirstName: | LYNSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6368 NARCISSUS AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945604507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104683574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 76 FENTON ST | ||||||||
| Address2: | |||||||||
| City: | LIVERMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945504144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254431800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2019 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.