Basic Information
| Provider Information | |||||||||
| NPI: | 1497774889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSSON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AUD.,CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 GLADES RD | ||||||||
| Address2: | 340 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334344167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613537377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7900 GLADES RD | ||||||||
| Address2: | 340 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334344167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613537377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY1174 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 6003940-00 | 05 | FL | MEDICAID |