Provider Demographics
NPI:1821236050
Name:ERICKSON, JAMIE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 E SHANNON AVE
Mailing Address - Street 2:APARTMENT H-101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1651
Mailing Address - Country:US
Mailing Address - Phone:509-990-5682
Mailing Address - Fax:
Practice Address - Street 1:12721 E SHANNON AVE
Practice Address - Street 2:APARTMENT H-101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1651
Practice Address - Country:US
Practice Address - Phone:509-990-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60022682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist