Healthcare Provider Details

I. General information

NPI: 1346440070
Provider Name (Legal Business Name): ERIC F. NIELSON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE LAKE RD SUITE 4
MILWAUKIE OR
97222-7759
US

IV. Provider business mailing address

PO BOX 1541
ESTACADA OR
97023-1541
US

V. Phone/Fax

Practice location:
  • Phone: 503-939-9024
  • Fax:
Mailing address:
  • Phone: 503-939-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: