Individual
MS. ERICA LYNN IDSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(541) 773-3863
(541) 776-2892
Mailing address
900 E MAIN ST, MEDFORD, OR 97504-7136
(541) 842-7704
(541) 842-7640
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2208
MN
Other
Enumeration date
07/10/2012
Last updated
07/17/2017
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