Provider Demographics
NPI:1457904518
Name:KOLLMAN, ERICKA
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:KOLLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30881 EKLUTNA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5166
Mailing Address - Country:US
Mailing Address - Phone:907-688-1750
Mailing Address - Fax:907-688-1770
Practice Address - Street 1:30881 EKLUTNA LAKE RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5166
Practice Address - Country:US
Practice Address - Phone:907-688-1750
Practice Address - Fax:907-688-1770
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)