Provider Demographics
NPI:1619098688
Name:EISENMANN, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:EISENMANN
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 1:301 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2838
Mailing Address - Country:US
Mailing Address - Phone:937-223-3446
Mailing Address - Fax:937-223-3484
Practice Address - Street 1:301 E 6TH ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2838
Practice Address - Country:US
Practice Address - Phone:937-223-3446
Practice Address - Fax:937-223-3484
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH96106H00000X
OH001139101YA0400X
OHF0000039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
2270702OtherCIGNA
7706638Y0NH01OtherANTHEM