Basic Information
| Provider Information | |||||||||
| NPI: | 1639821481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDBECK | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | MICKAELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5868 BAKER RD | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553455903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527274200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 ROLLING GREEN LN | ||||||||
| Address2: | |||||||||
| City: | NORTH MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560034442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527674200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.