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NPI Code Detail

MEDICARE: MRS. ALEXIS M EGGENBERGER MSSA, LISW-S, BCBA

MEDICARE:  MRS. ALEXIS M EGGENBERGER  MSSA, LISW-S, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1303111OH
2103K00000XBehavior Analyst1-14-17072

General Provider Information

NPI Number : 1518250950
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALEXIS M EGGENBERGER MSSA, LISW-S, BCBA
Provider Business Mailing Address
First Line : 14075 ECKEL JUNCTION RD
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-5734
Country : US
Telephone Number : 419-704-3408
Fax Number :
Provider Business Practice Location Address
First Line : 2105 LAWRENCE AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43606-4822
Country : US
Telephone Number : 419-291-7031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2011
Last Update Date : 05/05/2022

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Directions to “ MRS. ALEXIS M EGGENBERGER MSSA, LISW-S, BCBA” Practice Location

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