MEDICARE: MS. JUDITH MARIE EICHMAN SCHLEICH MS, LADC, LSW

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	301149	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	301149	OTHER	MN	LADC

General Provider Information

NPI Number	:	1548317605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH MARIE EICHMAN SCHLEICH MS, LADC, LSW

Provider Business Mailing Address
First Line	:	2116 CAMPUS DRIVE
Second Line	:	SUITE 105
City	:	ROCHESTER
State	:	MN
Zip	:	55904
Country	:	US
Telephone Number	:	507-281-6248
Fax Number	:	507-281-7392

Provider Business Practice Location Address
First Line	:	2116 CAMPUS DR SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4713
Country	:	US
Telephone Number	:	507-281-6248
Fax Number	:	507-281-7392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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