Provider Demographics
NPI:1649018953
Name:EICHMANN, KENNETH EUGENE (LADC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:EICHMANN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-1525
Mailing Address - Country:US
Mailing Address - Phone:507-676-2431
Mailing Address - Fax:
Practice Address - Street 1:47909 232ND ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-5259
Practice Address - Country:US
Practice Address - Phone:612-946-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)