Healthcare Provider Details

I. General information

NPI: 1336134329
Provider Name (Legal Business Name): ERIN A KEDROWICZ AU.D.- CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN A MCCARVILLE-CISESKI

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 MICHIGAN AVE
MANITOWOC WI
54220-3066
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-4380
  • Fax:
Mailing address:
  • Phone: 920-320-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number429
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number429
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: