Provider Demographics
NPI:1811469026
Name:INGOLIA, ERIKA DAWN (BCABA)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:DAWN
Last Name:INGOLIA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2206
Mailing Address - Country:US
Mailing Address - Phone:309-837-5506
Mailing Address - Fax:309-833-5506
Practice Address - Street 1:220 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2206
Practice Address - Country:US
Practice Address - Phone:309-837-5506
Practice Address - Fax:309-833-5506
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0-18-9193103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst