Healthcare Provider Details

I. General information

NPI: 1700621034
Provider Name (Legal Business Name): ERIN STENUM MS, LPC-IT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S 76TH ST STE 240
MILWAUKEE WI
53214-1599
US

IV. Provider business mailing address

1514 N 49TH ST
MILWAUKEE WI
53208-2251
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-4242
  • Fax:
Mailing address:
  • Phone: 414-899-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPAR-0000392019
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7989-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: