Individual
DR. ROGER LYNN ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3230 BROADMOOR AVE SE STE D, KENTWOOD, MI 49512-8180
(616) 228-1914
(616) 333-4927
Mailing address
3230 BROADMOOR AVE SE STE D, KENTWOOD, MI 49512-8180
(616) 228-1914
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016004
MI
103TR0400X
Rehabilitation Psychologist
6301016004
MI
Other
Enumeration date
05/24/2016
Last updated
03/21/2025
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