Basic Information
| Provider Information | |||||||||
| NPI: | 1992194773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOAN | ||||||||
| FirstName: | ERICKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 FRANK SCOTT PKWY W | ||||||||
| Address2: | SUITE 824 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622235007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2988 COURT ST | ||||||||
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| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2015 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
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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 | 225500000X | 146008374 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist |
No ID Information.