Individual
KELLY JEAN WITT-ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ICSW CPC
Contact information
Practice address
548 NORTH LAKE AVENUE, PHILLIPS, WI 54555
(715) 339-6453
Mailing address
W5213 WORCESTER LAKE ROAD, PRENTICE, WI 54556
(715) 360-0809
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3898-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39706000
—
WI
Enumeration date
10/19/2010
Last updated
10/19/2010
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