=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104731694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE ANN ERICKSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2026
-----------------------------------------------------
Last Update Date | 08/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 14TH AVE
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68949-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-5421
-----------------------------------------------------
Fax | 308-995-6956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 BURLINGTON ST
-----------------------------------------------------
City | HOLDREGE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68949-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-995-8663
-----------------------------------------------------
Fax | 308-995-6956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 20230009315
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------