Provider Demographics
NPI:1790504587
Name:MATTHEWS, ERICKA DAWN
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:DAWN
Last Name:MATTHEWS
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 1:3777 N 170 E
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7318
Mailing Address - Country:US
Mailing Address - Phone:435-590-4208
Mailing Address - Fax:
Practice Address - Street 1:1460 S PROVIDENCE CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1981
Practice Address - Country:US
Practice Address - Phone:435-586-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker