Provider Demographics
NPI:1386879617
Name:ERICKSON, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BEMIDJI AVE N
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3054
Mailing Address - Country:US
Mailing Address - Phone:218-308-2400
Mailing Address - Fax:651-431-7530
Practice Address - Street 1:800 BEMIDJI AVE N
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3054
Practice Address - Country:US
Practice Address - Phone:218-308-2400
Practice Address - Fax:651-431-7530
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND127712084P0800X
MN548062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry