Provider Demographics
NPI:1588900872
Name:JOHNSON, ERIN K (LPC-IT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:JOHNSON
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 1:406 TECHNOLOGY DR E
Mailing Address - Street 2:SUITE C
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2767
Mailing Address - Country:US
Mailing Address - Phone:715-635-4858
Mailing Address - Fax:
Practice Address - Street 1:406 TECHNOLOGY DR E
Practice Address - Street 2:SUITE C
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2767
Practice Address - Country:US
Practice Address - Phone:715-635-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1567-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional