Provider Demographics
NPI:1528836798
Name:ERICKSEN, CAMERON J
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:J
Last Name:ERICKSEN
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 1:29091 SW SAN MIGUEL LN
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-3109
Mailing Address - Country:US
Mailing Address - Phone:971-230-8161
Mailing Address - Fax:
Practice Address - Street 1:4141 N WILLIAMS AVE # 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2988
Practice Address - Country:US
Practice Address - Phone:971-230-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6008101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional