Basic Information
| Provider Information | |||||||||
| NPI: | 1477688703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12717 WRIGHTWOOD ST | ||||||||
| Address2: | |||||||||
| City: | CEDAR LAKE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463039459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193744365 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 W CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463123260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193926061 | ||||||||
| FaxNumber: | 2197571950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 12/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34005755A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.