MEDICARE: ERICA KING

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1063975704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA KING

Provider Business Mailing Address
First Line	:	3934 N 86TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2861
Country	:	US
Telephone Number	:	414-841-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	8018 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-737-1820
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	04/10/2019

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Directions to “ ERICA KING ” Practice Location

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