MEDICARE: ERICA E IVINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7471-226	WI
2	101YP2500X	Professional Counselor	12043-125	WI

General Provider Information

NPI Number	:	1053150052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA E IVINS

Provider Business Mailing Address
First Line	:	3658 S 89TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53228-1534
Country	:	US
Telephone Number	:	262-203-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S 5TH ST # 214
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2449
Country	:	US
Telephone Number	:	414-768-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	12/09/2025

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Directions to “ ERICA E IVINS ” Practice Location

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