Basic Information
| Provider Information | |||||||||
| NPI: | 1700544855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | BREANNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 886 100TH AVE | ||||||||
| Address2: | |||||||||
| City: | ROBERTS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540237602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514084317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 STAGELINE RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540167848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123393663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2021 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3044 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.