=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275975807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA EILER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2013
-----------------------------------------------------
Last Update Date | 07/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 W WISCONSIN AVE SUITE 1810
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-271-3322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 488
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-620-1806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------