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NPI Code Detail

MEDICARE: DR. KIRK L ERICKSON PSY.D.

MEDICARE: DR. KIRK L ERICKSON PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1184632861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIRK L ERICKSON PSY.D.
Provider Business Mailing Address
First Line : 820 E OLD WILLOW RD APT 214
Second Line :
City : PROSPECT HEIGHTS
State : IL
Zip : 60070-2114
Country : US
Telephone Number : 847-933-0051
Fax Number : 847-933-0057
Provider Business Practice Location Address
First Line : 8324 SKOKIE BLVD
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2545
Country : US
Telephone Number : 847-933-0051
Fax Number : 847-933-0057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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