Provider Demographics
NPI:1548317605
Name:EICHMAN SCHLEICH, JUDITH MARIE (MS, LADC, LSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:EICHMAN SCHLEICH
Suffix:
Gender:F
Credentials:MS, LADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-281-6248
Mailing Address - Fax:507-281-7392
Practice Address - Street 1:2116 CAMPUS DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4713
Practice Address - Country:US
Practice Address - Phone:507-281-6248
Practice Address - Fax:507-281-7392
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301149OtherLADC