Provider Demographics
NPI:1518343417
Name:DAUDT, ERICA R (LH60597585)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:R
Last Name:DAUDT
Suffix:
Gender:F
Credentials:LH60597585
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3257
Mailing Address - Country:US
Mailing Address - Phone:509-240-7266
Mailing Address - Fax:
Practice Address - Street 1:722 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3257
Practice Address - Country:US
Practice Address - Phone:509-240-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60504251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health