Provider Demographics
NPI:1477238665
Name:EYCHNER, LEA ROSE
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ROSE
Last Name:EYCHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-1825
Mailing Address - Country:US
Mailing Address - Phone:916-665-8084
Mailing Address - Fax:
Practice Address - Street 1:111 N SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1825
Practice Address - Country:US
Practice Address - Phone:916-665-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician