Provider Demographics
NPI:1841400876
Name:ERICKSON, MIRIAM ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ANNE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 FRANKLIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2899
Mailing Address - Country:US
Mailing Address - Phone:360-693-1333
Mailing Address - Fax:360-448-7337
Practice Address - Street 1:1409 FRANKLIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2899
Practice Address - Country:US
Practice Address - Phone:360-693-1333
Practice Address - Fax:360-448-7337
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical