Provider Demographics
NPI:1467852731
Name:VANDER MAY, ERIC MATTHEW
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MATTHEW
Last Name:VANDER MAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 HARRIET AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3472
Mailing Address - Country:US
Mailing Address - Phone:605-545-3010
Mailing Address - Fax:
Practice Address - Street 1:2544 HARRIET AVE
Practice Address - Street 2:APT 102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-3472
Practice Address - Country:US
Practice Address - Phone:605-545-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist