Provider Demographics
NPI:1417954041
Name:EICHMAN, MARY ANN (MS, LP)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:EICHMAN
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 7TH ST NW
Mailing Address - Street 2:STE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2666
Mailing Address - Country:US
Mailing Address - Phone:507-288-5675
Mailing Address - Fax:507-288-4240
Practice Address - Street 1:1027 7TH ST NW
Practice Address - Street 2:STE 1
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2666
Practice Address - Country:US
Practice Address - Phone:507-288-5675
Practice Address - Fax:507-288-4240
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2341103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4D027EIOtherBC/BS