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General NPI Number Information
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NPI Number | 1619257045
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Entity Type | Organization
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Legal Business Name | EICHENHOFER PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 1035 W GLEN OAKS LN SUITE 204
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City | MEQUON
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State | WI
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Zip | 53092-3392
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Country | US
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Telephone | 262-241-1515
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Fax | 262-241-4530
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Provider Business Mailing Address
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Address Line | 1035 W GLEN OAKS LN SUITE 204
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City | MEQUON
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State | WI
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Zip | 53092-3392
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Country | US
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Telephone | 262-241-1515
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Fax | 262-241-4530
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. DAVID JOHN EICHENHOFER JR.
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Credential | PH.D.
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Telephone | 262-241-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1457-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 308-124
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2989-123
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License Number State | WI
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