Provider Demographics
NPI:1023883162
Name:ERICKSON, JARED (NP-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3240
Mailing Address - Country:US
Mailing Address - Phone:425-346-5907
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 803
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1769
Practice Address - Country:US
Practice Address - Phone:206-208-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61504919207QA0505X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine