Provider Demographics
NPI:1376659201
Name:RANDI L. ERICKSON
Entity Type:Organization
Organization Name:RANDI L. ERICKSON
Other - Org Name:CROIX COUNSELING & PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D LP
Authorized Official - Phone:715-377-0000
Mailing Address - Street 1:2910 ENLOE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4538
Mailing Address - Country:US
Mailing Address - Phone:715-377-0000
Mailing Address - Fax:715-377-0010
Practice Address - Street 1:2910 ENLOE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4538
Practice Address - Country:US
Practice Address - Phone:715-377-0000
Practice Address - Fax:715-377-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689778748OtherINDIVIDUAL NPI NUMBER
WI39147000Medicaid
MN1689778748Medicaid