Basic Information
| Provider Information | |||||||||
| NPI: | 1790956290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURDOIN-ROGERS | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003288602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 WATER ST BLDG B1 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950604124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314236322 | ||||||||
| FaxNumber: | 8317223842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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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 | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | AU2558 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | CB272300 | 01 | CA | MEDICARE | OTHER | CB272299 | 01 | CA | MEDICARE | OTHER | CB272301 | 01 | CA | MEDICARE | OTHER |