Provider Demographics
NPI:1568113892
Name:ERICKSON, ANGELA (LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5002
Mailing Address - Country:US
Mailing Address - Phone:847-354-0712
Mailing Address - Fax:
Practice Address - Street 1:28 BARBERRY DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5002
Practice Address - Country:US
Practice Address - Phone:847-354-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150105858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker