Provider Demographics
NPI:1679629836
Name:ERICKSON, BERNADETTE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:362 KRISTIN CT E
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3584
Mailing Address - Country:US
Mailing Address - Phone:262-717-9008
Mailing Address - Fax:
Practice Address - Street 1:2825 N MAYFAIR RD
Practice Address - Street 2:101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4406
Practice Address - Country:US
Practice Address - Phone:414-453-6960
Practice Address - Fax:414-453-7080
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3210-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional