Provider Demographics
NPI:1770089401
Name:ERIC EHRKE LLC
Entity type:Organization
Organization Name:ERIC EHRKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-691-1470
Mailing Address - Street 1:N29W27355 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4323
Mailing Address - Country:US
Mailing Address - Phone:262-691-1470
Mailing Address - Fax:
Practice Address - Street 1:1166 QUAIL CT STE 210
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3775
Practice Address - Country:US
Practice Address - Phone:262-695-5311
Practice Address - Fax:262-695-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1782-123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center