Provider Demographics
NPI:1073996401
Name:EISELE, ERIKA LEIGH (PSYD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LEIGH
Last Name:EISELE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W FORT ST
Mailing Address - Street 2:CRH # 444, 2ND FLOOR
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4501
Mailing Address - Country:US
Mailing Address - Phone:208-422-1018
Mailing Address - Fax:
Practice Address - Street 1:11458 SE MCEACHRON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-1264
Practice Address - Country:US
Practice Address - Phone:503-305-6296
Practice Address - Fax:503-387-5279
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist