Provider Demographics
NPI:1518115385
Name:ERICKSON, KATHRYN BLEAZARD (NA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:BLEAZARD
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:NA
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BLEAZARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:474 W 200 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4505
Mailing Address - Country:US
Mailing Address - Phone:438-705-3633
Mailing Address - Fax:435-628-8911
Practice Address - Street 1:960 DIXIE DOWNS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-0612
Practice Address - Fax:435-628-8911
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical