Provider Demographics
NPI:1619684289
Name:ERICKSON, AUTUM L
Entity Type:Individual
Prefix:
First Name:AUTUM
Middle Name:L
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 1:151 SUNFISH PL NE UNIT G
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-2665
Mailing Address - Country:US
Mailing Address - Phone:507-316-8017
Mailing Address - Fax:
Practice Address - Street 1:140 ELTON HILLS LN NW STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3553
Practice Address - Country:US
Practice Address - Phone:507-722-1508
Practice Address - Fax:507-208-7735
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist