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General NPI Number Information
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NPI Number | 1124145081
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Entity Type | Individual
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Provider Name | BONNIE SUE ERICKSON ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 07/11/2020
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Provider Practice Location Address
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Address Line | 255 NE 6TH AVE
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City | ESTACADA
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State | OR
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Zip | 97023-9719
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Country | US
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Telephone | 503-630-8515
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Fax |
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Provider Business Mailing Address
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Address Line | 39344 TRILLIUM ST
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City | SANDY
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State | OR
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Zip | 97055-5399
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Country | US
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Telephone | 503-267-3003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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