Provider Demographics
NPI:1952760043
Name:TIEDEMAN, ERIN ELIZABETH (LPCC, LADC, LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:TIEDEMAN
Suffix:
Gender:F
Credentials:LPCC, LADC, LAC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S935B CHRISTMAS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-9608
Mailing Address - Country:US
Mailing Address - Phone:605-759-3955
Mailing Address - Fax:
Practice Address - Street 1:S935B CHRISTMAS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-9608
Practice Address - Country:US
Practice Address - Phone:605-759-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302604101YA0400X
MNLPCC371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)