Provider Demographics
NPI:1972874766
Name:EICH, JEAN EDITH (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:EDITH
Last Name:EICH
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 HUDSON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1018
Mailing Address - Country:US
Mailing Address - Phone:952-460-9024
Mailing Address - Fax:651-714-9029
Practice Address - Street 1:6043 HUDSON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1018
Practice Address - Country:US
Practice Address - Phone:952-460-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical