Provider Demographics
NPI:1679130033
Name:ERICKSON, RACHAEL LYNNE (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNNE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 S LINCOLN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2725
Mailing Address - Country:US
Mailing Address - Phone:720-319-7614
Mailing Address - Fax:
Practice Address - Street 1:8000 S LINCOLN ST STE 10
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2725
Practice Address - Country:US
Practice Address - Phone:720-319-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-17-32754106S00000X
CO1-21-56303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician