Provider Demographics
NPI:1467448290
Name:ECKERT, KAYE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAYE
Middle Name:MARIE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 FOSSE CT
Mailing Address - Street 2:
Mailing Address - City:NEKOOSA
Mailing Address - State:WI
Mailing Address - Zip Code:54457-8799
Mailing Address - Country:US
Mailing Address - Phone:715-325-2852
Mailing Address - Fax:
Practice Address - Street 1:108 E NORTH ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934-9443
Practice Address - Country:US
Practice Address - Phone:608-339-4511
Practice Address - Fax:608-339-4593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 2093103T00000X
WI2093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39724000Medicaid
WI39724000Medicaid