Provider Demographics
NPI:1689238172
Name:EITTREIM, ERIC STEPHEN
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEPHEN
Last Name:EITTREIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 W 27TH ST STUDENT HEALTH CENTER 103
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0385
Mailing Address - Country:US
Mailing Address - Phone:319-273-2676
Mailing Address - Fax:319-273-6884
Practice Address - Street 1:1227 W 27TH ST STUDENT HEALTH CENTER 103
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0385
Practice Address - Country:US
Practice Address - Phone:319-273-2676
Practice Address - Fax:319-273-6884
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health