MEDICARE: BARBARA JEAN EGGENBERGER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	T0613	OR
2	106H00000X	Marriage & Family Therapist	MC37016	CA

General Provider Information

NPI Number	:	1114164829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JEAN EGGENBERGER MFT

Provider Business Mailing Address
First Line	:	1905 22ND ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7108
Country	:	US
Telephone Number	:	916-201-9304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 22ND ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7108
Country	:	US
Telephone Number	:	916-484-5016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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