Provider Demographics
NPI:1669507414
Name:EICHINGER, CAROL NODDINGS (MS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:NODDINGS
Last Name:EICHINGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:SUE NODDINGS
Other - Last Name:EICHINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4652 N ELM TREE RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6502
Mailing Address - Country:US
Mailing Address - Phone:414-332-8816
Mailing Address - Fax:
Practice Address - Street 1:6682 W GREENFIELD AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-4960
Practice Address - Country:US
Practice Address - Phone:414-475-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1283218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40934800Medicaid