Provider Demographics
NPI:1588309215
Name:ERICKSON, KIMBERLY MICHELLE (MS, CCC-SLP; WDP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP; WDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 W STEPHEN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8725
Mailing Address - Country:US
Mailing Address - Phone:801-759-1098
Mailing Address - Fax:
Practice Address - Street 1:2327 W STEPHEN LN
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8725
Practice Address - Country:US
Practice Address - Phone:801-759-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT315975-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist