Healthcare Provider Details

I. General information

NPI: 1205532827
Provider Name (Legal Business Name): ERICA SOLETSKI MSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N BROADWAY
GREEN BAY WI
54303-3426
US

IV. Provider business mailing address

606 14TH AVE
GREEN BAY WI
54303-1738
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-7206
  • Fax:
Mailing address:
  • Phone: 920-819-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12142123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: