Provider Demographics
NPI:1316390719
Name:ERRICSON, SEANNA MAE
Entity Type:Individual
Prefix:
First Name:SEANNA
Middle Name:MAE
Last Name:ERRICSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10892 SE OREGOLD CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6092
Mailing Address - Country:US
Mailing Address - Phone:503-320-7020
Mailing Address - Fax:503-482-5828
Practice Address - Street 1:10892 SE OREGOLD CT
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-6092
Practice Address - Country:US
Practice Address - Phone:503-320-7020
Practice Address - Fax:503-482-5828
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist