Healthcare Provider Details

I. General information

NPI: 1922591395
Provider Name (Legal Business Name): ERIN CIMINO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN CIMINO LPC IT

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MARSHALL ST STE A
WAUSAU WI
54403-6799
US

IV. Provider business mailing address

2400 MARSHALL ST STE A
WAUSAU WI
54403-6799
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-4600
  • Fax:
Mailing address:
  • Phone: 715-848-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: