MEDICARE: NATALIE MARIE EDDY M.A.

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1770917957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MARIE EDDY M.A.

Provider Business Mailing Address
First Line	:	400 W RIVER DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53090-1518
Country	:	US
Telephone Number	:	262-334-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	7280 S 13TH ST
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-1831
Country	:	US
Telephone Number	:	262-334-4340
Fax Number	:

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

Provider Enumeration Date	:	08/24/2013
Last Update Date	:	10/17/2023

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