Provider Demographics
NPI:1407900772
Name:ECKHARDT, JANELLE RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:RUTH
Last Name:ECKHARDT
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 1:1524 W HAYS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4035
Mailing Address - Country:US
Mailing Address - Phone:208-345-8712
Mailing Address - Fax:208-345-1550
Practice Address - Street 1:1524 W HAYS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4035
Practice Address - Country:US
Practice Address - Phone:208-345-8712
Practice Address - Fax:208-345-1550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID202132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical