| Doctor Name: | DR. KIRK WAYNE ERICKSON |
| NPI Number: | 1629346853 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 071004736 |
| Business Practice Address: | 4160 Route 83 Suite 204 Long Grove, IL - 600475083 |
| Business Phone Number: | 8476040734 |
| Business Fax Number: | |
| Mailing Address: | 4160 Rte 83, Suite 204, LONG GROVE |
| State: | IL |
| Postal Code: | 60047 |
| Phone Number: | 8476040734 |
| Fax Number: | |
| NPI Enumeration Date: | 12/02/2011 |
| NPI Last Update Date: | 12/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071004736 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |