Healthcare Provider Details

I. General information

NPI: 1487594594
Provider Name (Legal Business Name): ERIC M HERZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W WELLS ST
MILWAUKEE WI
53233-2720
US

IV. Provider business mailing address

2020 W WELLS ST
MILWAUKEE WI
53233-2720
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-9675
  • Fax: 414-476-9675
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-476-9675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12183-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: