Individual
DR. KIRK WAYNE ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4160 ROUTE 83, SUITE 204, LONG GROVE, IL 60047-5083
(847) 604-0734
Mailing address
4160 RTE 83, SUITE 204, LONG GROVE, IL 60047
(847) 604-0734
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004736
IL
Other
Enumeration date
12/02/2011
Last updated
12/02/2011
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