Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP2934 | FM |
NPI | 1093836983 |
---|---|
Provider Name | Barbara Olivia Erickson |
First Address | Pine City, MN 55063-5511 |
Second Address | Cambridge, MN 55008-1536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41 29 713 | MN TAXID NUMBER (01) | MN |