Provider Demographics
NPI:1982600706
Name:ERICKSEN, TODD D (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:ERICKSEN
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25147 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5497
Mailing Address - Country:US
Mailing Address - Phone:507-454-1247
Mailing Address - Fax:507-452-3422
Practice Address - Street 1:25147 COUNTY ROAD 17
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5497
Practice Address - Country:US
Practice Address - Phone:507-454-1247
Practice Address - Fax:507-452-3422
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5013237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN181195OtherUCARE
MN70G55EROtherBCBS MN