Individual
AMY MARIE ERICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.T.
Contact information
Practice address
3718 GNARL TREE LN, CHERRY VALLEY, IL 61016-9678
(815) 742-8272
Mailing address
3718 GNARL TREE LN, CHERRY VALLEY, IL 61016-9678
(815) 742-8272
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
AE05370202P
IL
Other
Enumeration date
06/12/2007
Last updated
07/08/2007
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