Provider Demographics
NPI:1942914254
Name:ERICKSON, JENNA (LPC-IT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 LAWRENCE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-570-6339
Mailing Address - Fax:
Practice Address - Street 1:1710 LAWRENCE DR
Practice Address - Street 2:STE 200
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-570-6339
Practice Address - Fax:920-243-6339
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5264-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional