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General NPI Number Information
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NPI Number | 1629472899
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Entity Type | Individual
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Provider Name | ERICA MONZINGO SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1626 CLARENCE CT
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City | WEST BEND
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State | WI
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Zip | 53095-8533
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Country | US
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Telephone | 262-338-8611
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Fax |
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST STE 2210
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City | WEST ALLIS
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State | WI
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Zip | 53214-5650
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Country | US
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Telephone | 414-777-1570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16878-130
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License Number State | WI
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