Provider Demographics
NPI:1477138063
Name:DICKSON, ERIN MARIA (MT-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIA
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIA
Other - Last Name:BAUMLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VALLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5064
Mailing Address - Country:US
Mailing Address - Phone:701-388-0324
Mailing Address - Fax:
Practice Address - Street 1:763 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2045
Practice Address - Country:US
Practice Address - Phone:701-388-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist