Provider Demographics
NPI:1609076322
Name:WARREN, EILEEN G (MS, CSAC - ICS)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:G
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, CSAC - ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5111
Mailing Address - Country:US
Mailing Address - Phone:262-456-4780
Mailing Address - Fax:262-605-4858
Practice Address - Street 1:6501 3RD AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5111
Practice Address - Country:US
Practice Address - Phone:262-456-4780
Practice Address - Fax:262-456-4780
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11581 - 134 AND2103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)