Provider Demographics
NPI:1427571256
Name:DEBORAH K ERICKSON PLLC
Entity Type:Organization
Organization Name:DEBORAH K ERICKSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-485-1025
Mailing Address - Street 1:1162 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1411
Mailing Address - Country:US
Mailing Address - Phone:651-485-1025
Mailing Address - Fax:
Practice Address - Street 1:2151 HAMLINE AVE N STE 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4226
Practice Address - Country:US
Practice Address - Phone:651-800-1127
Practice Address - Fax:763-703-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285929968OtherNPI INDIVIDUAL