Provider Demographics
NPI:1508254400
Name:ERICSSON, KRISTEN (MS, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ERICSSON
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 S TENNIS LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2256
Mailing Address - Country:US
Mailing Address - Phone:605-270-1057
Mailing Address - Fax:
Practice Address - Street 1:4410 S TENNIS LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2256
Practice Address - Country:US
Practice Address - Phone:605-270-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program