Individual
AUDRA ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, LMT
Contact information
Practice address
4415 NE SANDY BLVD STE 207, PORTLAND, OR 97213-1400
(541) 484-7563
Mailing address
3829 SE 68TH AVE, PORTLAND, OR 97206-3527
(541) 484-7563
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21710
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21710
STATE LICENSE
OR
Enumeration date
10/14/2016
Last updated
01/14/2021
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