Provider Demographics
NPI:1801831680
Name:NIEHAUS, EILEEN MARY (MS LP)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARY
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:MS LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2614
Mailing Address - Country:US
Mailing Address - Phone:320-252-5010
Mailing Address - Fax:320-203-1855
Practice Address - Street 1:730 DODGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2889
Practice Address - Country:US
Practice Address - Phone:763-441-3770
Practice Address - Fax:763-441-9057
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN922241022561OtherPREFERRED ONE
19629OtherOPTUM
MN69138NIOtherBLUE CROSS BLUE SHIELD
HP25552OtherHEALTH PARTNERS
6200991OtherMEDICA