Healthcare Provider Details

I. General information

NPI: 1033978796
Provider Name (Legal Business Name): ERICKA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 W CAPITOL DR
MILWAUKEE WI
53216-2070
US

IV. Provider business mailing address

6815 W CAPITOL DR
MILWAUKEE WI
53216-2070
US

V. Phone/Fax

Practice location:
  • Phone: 414-909-1079
  • Fax:
Mailing address:
  • Phone: 414-909-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8829-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: