Provider Demographics
NPI:1831646892
Name:ERICKSON, KENDA (MC, MAC, CDP)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MC, MAC, CDP
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 2371
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-2371
Mailing Address - Country:US
Mailing Address - Phone:425-363-2020
Mailing Address - Fax:425-831-5428
Practice Address - Street 1:1308 BOALCH AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8908
Practice Address - Country:US
Practice Address - Phone:425-363-2020
Practice Address - Fax:425-831-5428
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)