MEDICARE: ERIN TENAGLIA LPC

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	101YM0800X	Mental Health Counselor	10624	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10624	OTHER	WI	STATE LICENSE

General Provider Information

NPI Number	:	1669194700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN TENAGLIA LPC

Provider Business Mailing Address
First Line	:	7330 W LAYTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-3849
Country	:	US
Telephone Number	:	414-877-4570
Fax Number	:	414-304-8065

Provider Business Practice Location Address
First Line	:	10424 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4331
Country	:	US
Telephone Number	:	414-877-4570
Fax Number	:	414-774-1488

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

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/19/2023

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