MEDICARE: ERIC WITTKOPF

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	1829	MN

General Provider Information

NPI Number	:	1487116307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WITTKOPF

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W STE N180
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2803
Country	:	US
Telephone Number	:	651-366-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W STE N180
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2803
Country	:	US
Telephone Number	:	651-366-2054
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/01/2019

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Directions to “ ERIC WITTKOPF ” Practice Location

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