Provider Demographics
NPI:1336344985
Name:ERICKSON-MICHELS, JESSICA E (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:ERICKSON-MICHELS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3075 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-3945
Mailing Address - Country:US
Mailing Address - Phone:715-202-4097
Mailing Address - Fax:
Practice Address - Street 1:3075 155TH AVE
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-3945
Practice Address - Country:US
Practice Address - Phone:715-202-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10817-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist