Healthcare Provider Details

I. General information

NPI: 1679222442
Provider Name (Legal Business Name): ERIKA EVANGELINE RILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

16 GOLDFINCH LN APT 1
CARBONDALE IL
62901-7192
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax:
Mailing address:
  • Phone: 951-202-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149027134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: