MEDICARE: ERIKA LYNN BROXTON

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132309-121	OTHER	WI	SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1235760711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LYNN BROXTON

Provider Business Mailing Address
First Line	:	4241 W HAWTHORNE TRACE RD APT 103
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-1033
Country	:	US
Telephone Number	:	262-573-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 W CONCORDIA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3853
Country	:	US
Telephone Number	:	414-253-7494
Fax Number	:	414-296-0273

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	12/28/2021

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