Provider Demographics
NPI:1043838667
Name:ERICKSON, ASHLEY RACHELLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RACHELLE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CLOQUET AVE # 216
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1620
Mailing Address - Country:US
Mailing Address - Phone:218-591-4784
Mailing Address - Fax:
Practice Address - Street 1:3609 COUNTY ROAD 143
Practice Address - Street 2:
Practice Address - City:MAHTOWA
Practice Address - State:MN
Practice Address - Zip Code:55707-8643
Practice Address - Country:US
Practice Address - Phone:218-591-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2045542163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2045542OtherRN, IBCLC PROVIDING LACTATION SERVICES