Provider Demographics
NPI:1114078359
Name:ERICKSON, LOIS DEVONALD (PHD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:DEVONALD
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAKELAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3434
Mailing Address - Country:US
Mailing Address - Phone:618-235-2379
Mailing Address - Fax:
Practice Address - Street 1:113 LAKELAND HILLS DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3434
Practice Address - Country:US
Practice Address - Phone:618-235-2379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional