1619028438 NPI number — CHRISTINA MARIE ECKES CADC II, LPC

Table of content: CHRISTINA MARIE ECKES CADC II, LPC (NPI 1619028438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619028438 NPI number — CHRISTINA MARIE ECKES CADC II, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKES
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC II, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKE
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619028438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
S4758 STATE HIGHWAY 80
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54634-8220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-643-3147
Provider Business Mailing Address Fax Number:
608-643-3178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE-B
Provider Business Practice Location Address City Name:
REEDSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53959-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-524-5151
Provider Business Practice Location Address Fax Number:
608-524-5353
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  560-126 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: 15179 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com