Provider Demographics
NPI:1326422676
Name:ERICKSON, AMBER (MA60566782)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA60566782
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4141
Mailing Address - Country:US
Mailing Address - Phone:509-378-8368
Mailing Address - Fax:
Practice Address - Street 1:1319 LEE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4141
Practice Address - Country:US
Practice Address - Phone:509-378-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60566782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist