Provider Demographics
NPI:1215534730
Name:ERICKSON, LINDA KELLEE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KELLEE
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 1:3810 RUM RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1103
Mailing Address - Country:US
Mailing Address - Phone:763-392-0172
Mailing Address - Fax:
Practice Address - Street 1:227 STALLION LN
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-7014
Practice Address - Country:US
Practice Address - Phone:763-516-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor