Provider Demographics
NPI:1679548150
Name:JOHNSON, ERICKA SUE (AT,C)
Entity type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1833
Mailing Address - Country:US
Mailing Address - Phone:517-780-6002
Mailing Address - Fax:517-780-6003
Practice Address - Street 1:2345 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2211
Practice Address - Country:US
Practice Address - Phone:860-633-5572
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer