Provider Demographics
NPI:1285944900
Name:SWANSON, ERICKA JOY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:JOY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 S. 104TH AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464
Mailing Address - Country:US
Mailing Address - Phone:708-448-3300
Mailing Address - Fax:708-448-6972
Practice Address - Street 1:20550 LAGRANGE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:708-448-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007992103T00000X
IN20042445A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist