Provider Demographics
NPI:1093836983
Name:ERICKSON, BARBARA OLIVIA (MALP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:OLIVIA
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18851 BAYSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-5511
Mailing Address - Country:US
Mailing Address - Phone:651-245-5217
Mailing Address - Fax:
Practice Address - Street 1:237 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1536
Practice Address - Country:US
Practice Address - Phone:651-245-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FMLP2934103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41 29 713OtherMN TAXID NUMBER