Healthcare Provider Details

I. General information

NPI: 1649181470
Provider Name (Legal Business Name): KATELIN TINGEY EREKSON CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HILAND AVE
BURLEY ID
83318-2688
US

IV. Provider business mailing address

316 NEW HAVEN ST
RUPERT ID
83350-1177
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-4444
  • Fax:
Mailing address:
  • Phone: 801-592-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6781824
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: