Healthcare Provider Details

I. General information

NPI: 1194657213
Provider Name (Legal Business Name): ERICA PAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MAIN ST STE 403
PEORIA IL
61602-3133
US

IV. Provider business mailing address

107 W FOREST AVE
EAST PEORIA IL
61611-3032
US

V. Phone/Fax

Practice location:
  • Phone: 319-504-5698
  • Fax:
Mailing address:
  • Phone: 309-863-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: