Provider Demographics
NPI:1437483138
Name:LIDDICOAT, ERICA CHRISTINE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:CHRISTINE
Last Name:LIDDICOAT
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 1:4445 N PAULINA ST
Mailing Address - Street 2:APT D1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6332
Mailing Address - Country:US
Mailing Address - Phone:734-218-2736
Mailing Address - Fax:
Practice Address - Street 1:4445 N PAULINA ST
Practice Address - Street 2:APT D1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6332
Practice Address - Country:US
Practice Address - Phone:734-218-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst