Basic Information
| Provider Information | |||||||||
| NPI: | 1326217886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EICHMANN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | IDP-AT, SAC-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 HOME RD | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530391401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203863500 | ||||||||
| FaxNumber: | 9203863812 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 HOME RD | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530391401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203863500 | ||||||||
| FaxNumber: | 9203863812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 14636-130 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.