Provider Demographics
NPI:1275118192
Name:SEEBACH, ELIZABETH EMILY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EMILY
Last Name:SEEBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GLEN MARY RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4100
Mailing Address - Country:US
Mailing Address - Phone:608-406-0640
Mailing Address - Fax:
Practice Address - Street 1:112 GLEN MARY RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4100
Practice Address - Country:US
Practice Address - Phone:608-406-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1492103TC2200X, 103TC0700X
MNLP4946103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent