Provider Demographics
NPI:1619257045
Name:EICHENHOFER PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:EICHENHOFER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:EICHENHOFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-241-1515
Mailing Address - Street 1:1035 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3392
Mailing Address - Country:US
Mailing Address - Phone:262-241-1515
Mailing Address - Fax:262-241-4530
Practice Address - Street 1:1035 W GLEN OAKS LN
Practice Address - Street 2:SUITE 204
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3392
Practice Address - Country:US
Practice Address - Phone:262-241-1515
Practice Address - Fax:262-241-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1457-57103T00000X
WI2989-1231041C0700X
WI308-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty