Provider Demographics
NPI:1548245533
Name:EGGEN, KAREN LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LOUISE
Last Name:EGGEN
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 1:204 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5644
Mailing Address - Country:US
Mailing Address - Phone:219-531-0865
Mailing Address - Fax:219-548-0875
Practice Address - Street 1:204 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5644
Practice Address - Country:US
Practice Address - Phone:219-531-0865
Practice Address - Fax:219-548-0875
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040698A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR25592Medicare UPIN
IN658720Medicare ID - Type Unspecified