Provider Demographics
NPI:1891981460
Name:WHITE-FISH, ERIN LEE
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LEE
Last Name:WHITE-FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:LEE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1150 ROUTE 54 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2148
Mailing Address - Country:US
Mailing Address - Phone:217-935-9496
Mailing Address - Fax:217-935-4508
Practice Address - Street 1:1150 ROUTE 54 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2148
Practice Address - Country:US
Practice Address - Phone:217-935-9496
Practice Address - Fax:217-935-4508
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)