Healthcare Provider Details

I. General information

NPI: 1891071312
Provider Name (Legal Business Name): ERIN CLAIRE SANDER M.S., SPEECH-LANGUAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH COLUMBIA ROAD
GRAND FORKS ND
58206-6002
US

IV. Provider business mailing address

PO BOX 6002
GRAND FORKS ND
58206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax:
Mailing address:
  • Phone: 701-780-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2011025915
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2011025915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: