Provider Demographics
NPI:1841602893
Name:CORDER-ERICKSON, TERESA (MED, EDS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:CORDER-ERICKSON
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42101 GRISWOLD RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2117
Mailing Address - Country:US
Mailing Address - Phone:440-284-8263
Mailing Address - Fax:440-284-8115
Practice Address - Street 1:42101 GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2117
Practice Address - Country:US
Practice Address - Phone:440-284-8263
Practice Address - Fax:440-284-8115
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist