Provider Demographics
NPI:1477983336
Name:ERICKSON, KRISTEN ANN (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E SINTO AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1838
Mailing Address - Country:US
Mailing Address - Phone:509-217-3249
Mailing Address - Fax:
Practice Address - Street 1:12121 E BROADWAY AVE
Practice Address - Street 2:BLDG 5B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4972
Practice Address - Country:US
Practice Address - Phone:509-921-9800
Practice Address - Fax:509-921-9810
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60416070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist