Provider Demographics
NPI:1285872796
Name:ERIKSON INSTITUTE
Entity type:Organization
Organization Name:ERIKSON INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LICENSED CLINICAL PSYCHOLO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGRET
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-893-7194
Mailing Address - Street 1:451 N LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4510
Mailing Address - Country:US
Mailing Address - Phone:312-892-7119
Mailing Address - Fax:
Practice Address - Street 1:451 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4510
Practice Address - Country:US
Practice Address - Phone:312-893-7194
Practice Address - Fax:312-893-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty