Basic Information
| Provider Information | |||||||||
| NPI: | 1669525457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMERSON | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCCSLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 917770 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328917770 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13101 BRUCE B DOWNS BLVD | ||||||||
| Address2: | CMS | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336123803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139740602 | ||||||||
| FaxNumber: | 8132508875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA7934 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 11174701 | 01 | FL | CITRUS HMO | OTHER | 890362000 | 05 | FL | MEDICAID | 355141 | 01 | FL | WELLCARE HMO | OTHER | S2899 | 01 | FL | BCBS | OTHER |