| Doctor Name: | ERIN ELIZABETH TIEDEMAN |
| NPI Number: | 1952760043 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC, LADC, LAC |
| License Number: | 302604 |
| Business Practice Address: | S935b Christmas Mountain Rd Wisconsin Dells, WI - 539659608 |
| Business Phone Number: | 6057593955 |
| Business Fax Number: | |
| Mailing Address: | S935b Christmas Mountain Rd, WISCONSIN DELLS |
| State: | WI |
| Postal Code: | 539659608 |
| Phone Number: | 6057593955 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2016 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302604 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |