Provider Demographics
NPI:1689286213
Name:LILJEDAHL, ERIKA LUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:LUISE
Last Name:LILJEDAHL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25461
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-5461
Mailing Address - Country:US
Mailing Address - Phone:312-451-6433
Mailing Address - Fax:
Practice Address - Street 1:325 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7024
Practice Address - Country:US
Practice Address - Phone:312-451-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006560103TC0700X
MO2013014520103TC0700X
CO0005306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical