Healthcare Provider Details

I. General information

NPI: 1841201696
Provider Name (Legal Business Name): KRISTINE V EICKHOFF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY CARTWRIGHT

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 WATSON RD SUITE 100
SAINT LOUIS MO
63119-5100
US

IV. Provider business mailing address

8711 WATSON RD SUITE 100
SAINT LOUIS MO
63119-5100
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-9871
  • Fax: 314-961-9877
Mailing address:
  • Phone: 314-961-9871
  • Fax: 314-961-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number01645
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: