Provider Demographics
NPI:1497848196
Name:ERICKSON, TRICIA ANN (MA, MA, RD, CPHQ)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA, MA, RD, CPHQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E LITCHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759
Mailing Address - Country:US
Mailing Address - Phone:860-489-0367
Mailing Address - Fax:860-585-3081
Practice Address - Street 1:9 E LITCHFIELD LN
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759
Practice Address - Country:US
Practice Address - Phone:860-631-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered