Provider Demographics
NPI:1679702864
Name:BODIE, ERICA MICHELLE (AUD)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MICHELLE
Last Name:BODIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:MICHELLE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3285 S. VAL VISTA DR
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:480-397-2800
Mailing Address - Fax:602-263-1631
Practice Address - Street 1:3285 S. VAL VISTA DR
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-397-2898
Practice Address - Fax:602-263-1631
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA6250231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter