Provider Demographics
NPI:1164864674
Name:ERICKSON, MELISSA ANN (CMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HIGHWAY 23 STE 104
Mailing Address - Street 2:PO BOX 426
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-9109
Mailing Address - Country:US
Mailing Address - Phone:320-968-6023
Mailing Address - Fax:320-968-6206
Practice Address - Street 1:1061 HIGHWAY 23 STE 104
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-9109
Practice Address - Country:US
Practice Address - Phone:320-968-6023
Practice Address - Fax:320-968-6206
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist