Healthcare Provider Details

I. General information

NPI: 1619706512
Provider Name (Legal Business Name): ERIKA KLYCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 SW 5TH ST STE 2
REDMOND OR
97756-2150
US

IV. Provider business mailing address

258 SW 5TH ST STE 2
REDMOND OR
97756-2150
US

V. Phone/Fax

Practice location:
  • Phone: 541-516-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9577
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: