Provider Demographics
NPI:1437505112
Name:ERICKSEN, SHAUNA (ATC)
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CASTILLO ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-5708
Mailing Address - Country:US
Mailing Address - Phone:805-588-8837
Mailing Address - Fax:
Practice Address - Street 1:230 CASTILLO ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-5708
Practice Address - Country:US
Practice Address - Phone:805-588-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer