Individual
BRENT ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, SAC
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
2901 HUNTERS TRL, P.O. BOX 301, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1521
WI
104100000X
Social Worker
Primary
1783-123
WI
1041C0700X
Clinical Social Worker
1783-123
WI
Other
Enumeration date
09/26/2006
Last updated
05/21/2015
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