Individual
MISS INGA ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
875 PERIMETER DR # MS 2302, MOSCOW, ID 83844-9803
(360) 640-4553
(208) 885-0254
Mailing address
875 PERIMETER DR # MS 2302, MOSCOW, ID 83844-2302
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-828
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000050553
BOARD OF CERTIFICATION- ATHLETIC TRAINING
—
Enumeration date
09/27/2022
Last updated
09/27/2022
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