Provider Demographics
NPI:1245992726
Name:MIKALSEN, ERIN P (RBT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:MIKALSEN
Suffix:
Gender:F
Credentials:RBT
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 531125
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32853-1125
Mailing Address - Country:US
Mailing Address - Phone:407-218-4340
Mailing Address - Fax:407-218-4303
Practice Address - Street 1:758 N SUN DR STE 112
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2599
Practice Address - Country:US
Practice Address - Phone:407-317-5429
Practice Address - Fax:321-800-7201
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-187914106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician