Provider Demographics
NPI:1669507265
Name:EGGEN, ELLEN ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:EGGEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:ELIZABETH
Other - Last Name:EGGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:717 ORION TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2927
Mailing Address - Country:US
Mailing Address - Phone:608-347-0075
Mailing Address - Fax:
Practice Address - Street 1:1717 N STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-2605
Practice Address - Country:US
Practice Address - Phone:608-838-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI3849-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker