Healthcare Provider Details

I. General information

NPI: 1104731694
Provider Name (Legal Business Name): STEPHANIE ANN ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 14TH AVE
HOLDREGE NE
68949-1300
US

IV. Provider business mailing address

709 BURLINGTON ST
HOLDREGE NE
68949-2160
US

V. Phone/Fax

Practice location:
  • Phone: 308-995-5421
  • Fax: 308-995-6956
Mailing address:
  • Phone: 308-995-8663
  • Fax: 308-995-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number20230009315
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: