Basic Information
| Provider Information | |||||||||
| NPI: | 1821550583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNI | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 W RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571041322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052712690 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 848 EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327657699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052712690 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-78738 | FL | Y |
ID Information
| ID | Type | State | Issuer | Description | 102465800 | 05 | FL | MEDICAID |