Healthcare Provider Details

I. General information

NPI: 1336676634
Provider Name (Legal Business Name): KRISTEN ERICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NE HOOD AVE
GRESHAM OR
97030-7450
US

IV. Provider business mailing address

304 NE HOOD AVE
GRESHAM OR
97030-7450
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-1333
  • Fax: 503-666-2444
Mailing address:
  • Phone: 503-666-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number13285
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: