Healthcare Provider Details

I. General information

NPI: 1720400047
Provider Name (Legal Business Name): JENNIFER G ERICKSON MA, MS ED., CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY DR
DUBUQUE IA
52001-7303
US

IV. Provider business mailing address

200 MERCY DR
DUBUQUE IA
52001-7303
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-0145
  • Fax: 888-526-5456
Mailing address:
  • Phone: 563-582-0145
  • Fax: 888-526-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: