Provider Demographics
NPI:1164697215
Name:ERICKSON-MEIER, LYNN ELLEN (NBS-HIS #623)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELLEN
Last Name:ERICKSON-MEIER
Suffix:
Gender:F
Credentials:NBS-HIS #623
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 GUNDERSON ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3711
Mailing Address - Country:US
Mailing Address - Phone:262-483-4327
Mailing Address - Fax:262-895-7091
Practice Address - Street 1:4525 GUNDERSON ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-3711
Practice Address - Country:US
Practice Address - Phone:262-335-2327
Practice Address - Fax:262-335-2528
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI623237700000X
WINBC-HIS623237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42837000Medicaid