Provider Demographics
NPI:1609942689
Name:EICHENFIELD, GREGG A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:EICHENFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 IGLEHART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3522
Mailing Address - Country:US
Mailing Address - Phone:651-659-9715
Mailing Address - Fax:651-603-8528
Practice Address - Street 1:235 FAIRVIEW AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1551
Practice Address - Country:US
Practice Address - Phone:651-659-9715
Practice Address - Fax:651-603-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264053800Medicaid
MN264053800Medicaid