Provider Demographics
NPI:1073036208
Name:ERICKSON, CAROL LEE (ACA)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LEE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:ACA
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37446 WESTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1363
Mailing Address - Country:US
Mailing Address - Phone:559-284-6135
Mailing Address - Fax:
Practice Address - Street 1:56970 YUCCA TRL STE 102
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7911
Practice Address - Country:US
Practice Address - Phone:760-365-0691
Practice Address - Fax:760-365-0692
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4179237600000X
CAHA4179237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA4179OtherCALIFORNIA HEARING AID DESPENSER LIC.
CAHA4179OtherCALIFORNIA HEARING AID DESPENSER LIC.