Healthcare Provider Details

I. General information

NPI: 1881222016
Provider Name (Legal Business Name): ERICKA SWANSON PSYD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 CALUMET AVE STE A2
MUNSTER IN
46321-2888
US

IV. Provider business mailing address

14917 98TH AVE
DYER IN
46311-2944
US

V. Phone/Fax

Practice location:
  • Phone: 219-805-0451
  • Fax:
Mailing address:
  • Phone: 219-688-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HOOVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-688-6158