Healthcare Provider Details

I. General information

NPI: 1548245533
Provider Name (Legal Business Name): KAREN LOUISE EGGEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E LINCOLNWAY
VALPARAISO IN
46383-5644
US

IV. Provider business mailing address

204 E LINCOLNWAY
VALPARAISO IN
46383-5644
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-0865
  • Fax: 219-548-0875
Mailing address:
  • Phone: 219-531-0865
  • Fax: 219-548-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: