Provider Demographics
NPI:1124145081
Name:ERICKSON, BONNIE SUE (ATC, CSCS)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39344 TRILLIUM ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-5399
Mailing Address - Country:US
Mailing Address - Phone:503-267-3003
Mailing Address - Fax:
Practice Address - Street 1:255 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9719
Practice Address - Country:US
Practice Address - Phone:503-630-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer