Provider Demographics
NPI:1427250331
Name:ERICKSON, GENE K (BC-HIS, ACA)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:K
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S HIGLEY RD STE 119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3450
Mailing Address - Country:US
Mailing Address - Phone:480-495-0626
Mailing Address - Fax:480-985-7198
Practice Address - Street 1:1423 S HIGLEY RD STE 119
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3450
Practice Address - Country:US
Practice Address - Phone:480-495-0626
Practice Address - Fax:480-985-7198
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1532237700000X
261QH0700X, 332S00000X
AZHAD1532237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1532OtherDISPENSING LICENSE #