Healthcare Provider Details

I. General information

NPI: 1316633985
Provider Name (Legal Business Name): AMANDA ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 1ST AVE E
EUREKA MT
59917-0123
US

IV. Provider business mailing address

PO BOX 123
EUREKA MT
59917-0123
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-1413
  • Fax:
Mailing address:
  • Phone: 406-219-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11660
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: