Provider Demographics
NPI:1952887713
Name:EGGERDING, ELLEN RUTH (LLPC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:RUTH
Last Name:EGGERDING
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:RUTH
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 E RICH AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1922
Mailing Address - Country:US
Mailing Address - Phone:616-953-0042
Mailing Address - Fax:
Practice Address - Street 1:340 104TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9149
Practice Address - Country:US
Practice Address - Phone:616-953-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional