Provider Demographics
NPI:1942588298
Name:BODNER, ERIN ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:BODNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2243
Mailing Address - Country:US
Mailing Address - Phone:612-234-2080
Mailing Address - Fax:
Practice Address - Street 1:5012 UPTON AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2243
Practice Address - Country:US
Practice Address - Phone:612-234-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist