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Individual

TRISTAN ALBERT ERTMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
SAC-IT

Contact information

Practice address
530 STATE ROAD 67, KIEL, WI 53042-1650
(920) 894-1374
(920) 894-1373
Mailing address
530 STATE ROAD 67, KIEL, WI 53042-1650
(920) 894-1374
(920) 894-1373

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19029-130
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
46-1566338
PATHWAYS TO A BETTER LIFE
WI
Enumeration date
03/31/2021
Last updated
03/31/2021
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