MEDICARE: ERIC STROTHER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09927153	CO
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	9814-123	WI

General Provider Information

NPI Number	:	1053889402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC STROTHER LCSW

Provider Business Mailing Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9393
Fax Number	:	608-328-9480

Provider Business Practice Location Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9393
Fax Number	:	608-328-9480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2018
Last Update Date	:	04/15/2024

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