Provider Demographics
NPI:1225234545
Name:EICH, ELLEN (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:EICH
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 ROAD D
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9795
Mailing Address - Country:US
Mailing Address - Phone:707-485-1785
Mailing Address - Fax:
Practice Address - Street 1:275 W GOBBI ST
Practice Address - Street 2:SUITE C
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5451
Practice Address - Country:US
Practice Address - Phone:707-485-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist