Provider Demographics
NPI:1659645141
Name:ERICKSON, TIFFANY MARY (MS, ATC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 90TH ST E
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4349
Mailing Address - Country:US
Mailing Address - Phone:651-564-0442
Mailing Address - Fax:
Practice Address - Street 1:5228 90TH ST E
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-4349
Practice Address - Country:US
Practice Address - Phone:651-564-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer