Provider Demographics
NPI:1669510996
Name:JIMMERSON, ERINN MICHELLE (AUDCCC-A)
Entity Type:Individual
Prefix:MRS
First Name:ERINN
Middle Name:MICHELLE
Last Name:JIMMERSON
Suffix:
Gender:F
Credentials:AUDCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 20TH ST
Mailing Address - Street 2:CAMPUS BOX 55
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-6900
Mailing Address - Country:US
Mailing Address - Phone:970-351-2012
Mailing Address - Fax:970-351-1601
Practice Address - Street 1:22691 E AURORA PKWY
Practice Address - Street 2:SUITE B5
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6087
Practice Address - Country:US
Practice Address - Phone:303-400-2988
Practice Address - Fax:303-400-1227
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO449237600000X, 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
CO95336346Medicaid
CO261079YLN7Medicare PIN