Provider Demographics
NPI:1720849888
Name:EIGENMANN, PRAIRIE L
Entity Type:Individual
Prefix:
First Name:PRAIRIE
Middle Name:L
Last Name:EIGENMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 GRIFFITTS LN
Mailing Address - Street 2:
Mailing Address - City:SPAULDING
Mailing Address - State:IL
Mailing Address - Zip Code:62561-8211
Mailing Address - Country:US
Mailing Address - Phone:217-891-6379
Mailing Address - Fax:
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2499
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker