Provider Demographics
NPI:1467021451
Name:FORT, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5235
Mailing Address - Country:US
Mailing Address - Phone:414-841-5136
Mailing Address - Fax:
Practice Address - Street 1:383 WILLIAMSTOWNE STE 101
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2332
Practice Address - Country:US
Practice Address - Phone:262-337-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional