Individual
JESSICA LEIGH ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
147 COOPER LN E, CODY, WY 82414-9233
(307) 250-7522
Mailing address
27 JUSTICE LN, CODY, WY 82414-8253
(307) 250-7522
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-1145
WY
101YM0800X
Mental Health Counselor
LPC-1145
WY
101YP2500X
Professional Counselor
LPC-1145
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131309601
—
WY
Enumeration date
10/29/2007
Last updated
12/13/2014
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