Healthcare Provider Details

I. General information

NPI: 1801390448
Provider Name (Legal Business Name): HAYLEY ERICKSEN PHD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 N DOWNER AVE
MILWAUKEE WI
53211
US

IV. Provider business mailing address

3409 N DOWNER AVE
MILWAUKEE WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 414-229-5761
  • Fax:
Mailing address:
  • Phone: 414-229-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2046-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: