Provider Demographics
NPI:1376812792
Name:EISENGART, JULIE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:B
Last Name:EISENGART
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 1:909 DAVIS ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:SUITE 160
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3683
Practice Address - Country:US
Practice Address - Phone:847-425-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist