Provider Demographics
NPI:1841434925
Name:ERICKSON, SCOTT C (BC-HIS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 CEDAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4506
Mailing Address - Country:US
Mailing Address - Phone:952-891-1191
Mailing Address - Fax:952-891-1192
Practice Address - Street 1:14750 CEDAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4506
Practice Address - Country:US
Practice Address - Phone:952-891-1191
Practice Address - Fax:952-891-1192
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2379237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist