Active NPI
Brent Erickson, MS, SAC
- Social Worker
- Portage, WI
National Provider Identifier
1295836567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 1783-123
- Practice address
- 2901 Hunters TRL
Portage, WI 53901-3403 - Phone
- (608) 742-5518
- Fax
- (608) 742-4087
- NPI assigned
- Sep 26, 2006
- Last updated
- May 21, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1521 | WI | |
| Social Worker | 104100000X | 1783-123 | WI | Primary |
| Clinical Social Worker | 1041C0700X | 1783-123 | WI |
Addresses
Primary practice location
2901 Hunters TRL
Portage, WI 53901-3403
Mailing address
2901 Hunters TRL
P.O. Box 301
Portage, WI 53901-3403
Phone (608) 742-5518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1783-123 | WI | MD | Social Worker |
| 1521 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1295836567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 HUNTERS TRL",
"address_2": "P.O. BOX 301",
"city": "PORTAGE",
"state": "WI",
"postal_code": "539013403",
"telephone_number": "608-742-5518",
"fax_number": "608-742-4087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 HUNTERS TRL",
"city": "PORTAGE",
"state": "WI",
"postal_code": "539013403",
"telephone_number": "608-742-5518",
"fax_number": "608-742-4087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "BRENT",
"credential": "MS, SAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1521",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "1783-123",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "1783-123",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.