Provider Demographics
NPI:1457179947
Name:ERICKSON, LINDSEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4133
Mailing Address - Country:US
Mailing Address - Phone:303-810-7001
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON AVE S
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE IS
Practice Address - State:WA
Practice Address - Zip Code:98110-2544
Practice Address - Country:US
Practice Address - Phone:206-451-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-6037235Z00000X
WALL61514547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist