MEDICARE: ERICA MICHELLE ROBERTSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255126827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MICHELLE ROBERTSON

Provider Business Mailing Address
First Line	:	6426 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-5802
Country	:	US
Telephone Number	:	414-202-7802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 131
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-374-8787
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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