Provider Demographics
NPI:1336134329
Name:KEDROWICZ, ERIN A (AUD- CCCA)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:A
Last Name:KEDROWICZ
Suffix:
Gender:F
Credentials:AUD- CCCA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:MCCARVILLE-CISESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2591
Mailing Address - Fax:
Practice Address - Street 1:4303 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3066
Practice Address - Country:US
Practice Address - Phone:920-320-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI429237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI231H00000XMedicaid
WI1336134329OtherBCBS
WIP00917288OtherRR MEDICARE
WI001038055Medicare PIN
WI520207Medicare Oscar/Certification