Individual
SUSAN ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 TIJERAS AVE NW, ALBUQUERQUE, NM 87102-3099
(505) 242-1010
Mailing address
805 TIJERAS AVE NW, ALBUQUERQUE, NM 87102-3099
(505) 242-1010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21920869
—
NM
Enumeration date
08/09/2012
Last updated
08/09/2012
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