Provider Demographics
NPI:1528844057
Name:IMHOF, ERYKA GRACE
Entity type:Individual
Prefix:
First Name:ERYKA
Middle Name:GRACE
Last Name:IMHOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8812
Mailing Address - Country:US
Mailing Address - Phone:580-465-7393
Mailing Address - Fax:
Practice Address - Street 1:20 A ST NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6508
Practice Address - Country:US
Practice Address - Phone:580-448-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician