MEDICARE: ERIKA J WAGNER-MARTIN 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	635-226	WI

General Provider Information

NPI Number	:	1942507231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA J WAGNER-MARTIN LPC

Provider Business Mailing Address
First Line	:	2207 N 61ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-1501
Country	:	US
Telephone Number	:	414-839-7213
Fax Number	:	414-381-2324

Provider Business Practice Location Address
First Line	:	2207 N 61ST ST STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-1501
Country	:	US
Telephone Number	:	414-839-7213
Fax Number	:	414-381-2324

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

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	05/01/2026

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