Healthcare Provider Details

I. General information

NPI: 1669507265
Provider Name (Legal Business Name): ELLEN ELIZABETH EGGEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN ELIZABETH EGGEN LPC

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N STOUGHTON RD
MADISON WI
53704-2605
US

IV. Provider business mailing address

717 ORION TRL
MADISON WI
53718-2927
US

V. Phone/Fax

Practice location:
  • Phone: 608-838-9999
  • Fax:
Mailing address:
  • Phone: 608-347-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3849-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: