Provider Demographics
NPI:1083140727
Name:ATKINSON, ERNESTO (MA AT)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MA AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2986 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2562
Mailing Address - Country:US
Mailing Address - Phone:312-720-1615
Mailing Address - Fax:
Practice Address - Street 1:2986 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2562
Practice Address - Country:US
Practice Address - Phone:312-720-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6426-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0Medicaid