Provider Demographics
NPI:1982129110
Name:EISCHENS, EMILY CATHERINE (LADC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CATHERINE
Last Name:EISCHENS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:LEESEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-8362
Mailing Address - Country:US
Mailing Address - Phone:218-255-5703
Mailing Address - Fax:
Practice Address - Street 1:909 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304584101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)