Healthcare Provider Details

I. General information

NPI: 1689959413
Provider Name (Legal Business Name): ERICA LYNN VAN SERKE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 WILLOW CREEK RD
COLGATE WI
53017-9534
US

IV. Provider business mailing address

3294 WILLOW CREEK RD
COLGATE WI
53017-9534
US

V. Phone/Fax

Practice location:
  • Phone: 262-628-7825
  • Fax:
Mailing address:
  • Phone: 262-628-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3477-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: