| Doctor Name: | KELLY JEAN WITT-ERICKSON |
| NPI Number: | 1801106265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ICSW CPC |
| License Number: | 3898-123 |
| Business Practice Address: | 548 North Lake Avenue Phillips, WI - 54555 |
| Business Phone Number: | 7153396453 |
| Business Fax Number: | |
| Mailing Address: | W5213 Worcester Lake Road, PRENTICE |
| State: | WI |
| Postal Code: | 54556 |
| Phone Number: | 7153600809 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2010 |
| NPI Last Update Date: | 10/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 3898-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |