Provider Demographics
NPI:1497774889
Name:ANDERSSON, ERIN M (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:ANDERSSON
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 GLADES RD
Mailing Address - Street 2:340
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4167
Mailing Address - Country:US
Mailing Address - Phone:561-353-7377
Mailing Address - Fax:
Practice Address - Street 1:7900 GLADES RD
Practice Address - Street 2:340
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4167
Practice Address - Country:US
Practice Address - Phone:561-353-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1174231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6003940-00Medicaid