Provider Demographics
NPI:1376872705
Name:ERICKSON-ROBERTS, KRISTI ANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANNA
Last Name:ERICKSON-ROBERTS
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 1:405 KIPLING ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1559
Mailing Address - Country:US
Mailing Address - Phone:650-208-1472
Mailing Address - Fax:
Practice Address - Street 1:405 KIPLING ST APT 6
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1559
Practice Address - Country:US
Practice Address - Phone:650-208-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3651103TC0700X
MT408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75989751Medicaid