Provider Demographics
NPI:1518250950
Name:EGGENBERGER, ALEXIS M (MSSA, LISW-S, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:M
Last Name:EGGENBERGER
Suffix:
Gender:F
Credentials:MSSA, LISW-S, BCBA
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:M
Other - Last Name:LIEBENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA, LISW-S, BCBA
Mailing Address - Street 1:14075 ECKEL JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5734
Mailing Address - Country:US
Mailing Address - Phone:419-704-3408
Mailing Address - Fax:
Practice Address - Street 1:2105 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4822
Practice Address - Country:US
Practice Address - Phone:419-291-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13031111041C0700X
1-14-17072103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst