MEDICARE: MRS. ERICKA MARIE HAKANSON CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2007-10	MN

General Provider Information

NPI Number	:	1811171481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICKA MARIE HAKANSON CMT

Provider Business Mailing Address
First Line	:	7670 HYDE AVE S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-1977
Country	:	US
Telephone Number	:	651-748-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	5858 BLAINE AVE
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1400
Country	:	US
Telephone Number	:	652-457-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/19/2007

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