MEDICARE: ERICKSEN HEARING SERVICES, LLC

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	231H00000X	Audiologist	5013	MN

General Provider Information

NPI Number	:	1932518040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERICKSEN HEARING SERVICES, LLC

Provider Business Mailing Address
First Line	:	25147 COUNTY ROAD 17
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-5497
Country	:	US
Telephone Number	:	509-279-0251
Fax Number	:	866-350-0374

Provider Business Practice Location Address
First Line	:	25147 COUNTY ROAD 17
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987-5497
Country	:	US
Telephone Number	:	509-279-0251
Fax Number	:	866-350-0374

Authorized Official
Title or Position	:	AUDIOLOGIST & CHIEF MANAGER
Name	:	TODD ERICKSEN
Credential	:	M.A. CCC
Telephone Number	:	507-279-0251

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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