Provider Demographics
NPI:1477648111
Name:ECKLUND-JOHNSON, ERIC PHILLIP (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PHILLIP
Last Name:ECKLUND-JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:PHILLIP
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KANSAS HOSPITAL
Mailing Address - Street 2:3901 RAINBOW BLVD., MAIL STOP 1059
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-0294
Mailing Address - Fax:913-588-6964
Practice Address - Street 1:UNIVERSITY OF KANSAS HOSPITAL
Practice Address - Street 2:3901 RAINBOW BLVD., MAIL STOP 1059
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-0294
Practice Address - Fax:913-588-6964
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1387103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist