Provider Demographics
NPI:1437603123
Name:PETREE, ERIN LEIGH (LCPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:PETREE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:RUHNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-3002
Mailing Address - Fax:309-779-3026
Practice Address - Street 1:2200 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6308
Practice Address - Country:US
Practice Address - Phone:309-797-2900
Practice Address - Fax:309-797-2147
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional