MEDICARE: DR. GREGG A EICHENFIELD PH.D.

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	103T00000X	Psychologist	LP0229	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609942689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG A EICHENFIELD PH.D.

Provider Business Mailing Address
First Line	:	1836 IGLEHART AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3522
Country	:	US
Telephone Number	:	651-659-9715
Fax Number	:	651-603-8528

Provider Business Practice Location Address
First Line	:	235 FAIRVIEW AVE S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1551
Country	:	US
Telephone Number	:	651-659-9715
Fax Number	:	651-603-8528

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/22/2019

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