Provider Demographics
NPI:1871506790
Name:EICHENHOFER, DAVID J JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:EICHENHOFER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W GLEN OAKS LN STE 204
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3395
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 STE 204
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3395
Practice Address - Country:US
Practice Address - Phone:262-241-1515
Practice Address - Fax:262-241-4530
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1457057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist