Provider Demographics
NPI:1144334939
Name:DICKERSON, ERICA JEAN (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:JEAN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:JEAN
Other - Last Name:KRZEMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4851 MAYELIN NEAVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9597
Mailing Address - Country:US
Mailing Address - Phone:612-875-1392
Mailing Address - Fax:
Practice Address - Street 1:1800 2ND STREET NE
Practice Address - Street 2:A CHANCE TO GROW
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-706-5538
Practice Address - Fax:612-706-5555
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist