Provider Demographics
NPI:1700215035
Name:WARK MAY, ERIN MILLICENT
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MILLICENT
Last Name:WARK MAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MILLICENT
Other - Last Name:WARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25627 COUNTY HIGHWAY 48
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:MN
Mailing Address - Zip Code:56570-9502
Mailing Address - Country:US
Mailing Address - Phone:218-261-0867
Mailing Address - Fax:218-444-8337
Practice Address - Street 1:3835 SUPREME CT NW
Practice Address - Street 2:SUITE 2
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4446
Practice Address - Country:US
Practice Address - Phone:218-444-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist