Provider Demographics
NPI:1437651429
Name:ERICKSON, HAILEY ERIN (MS, QMHP)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ERIN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:ERIN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, QMHP
Mailing Address - Street 1:11010 SE DIVISION ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6400
Mailing Address - Country:US
Mailing Address - Phone:503-335-5975
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6400
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator