Healthcare Provider Details

I. General information

NPI: 1699312827
Provider Name (Legal Business Name): CORAL ERICA DIRKS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORAL ERICA HANSON

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9846
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: