Provider Demographics
NPI:1861613887
Name:CLAUDE W. EGGERTSEN, PHD, PLLC
Entity type:Organization
Organization Name:CLAUDE W. EGGERTSEN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:W
Authorized Official - Last Name:EGGERTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-752-0091
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-0747
Mailing Address - Country:US
Mailing Address - Phone:586-752-0091
Mailing Address - Fax:596-677-7809
Practice Address - Street 1:288 S MAIN ST
Practice Address - Street 2:STE. 1
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5133
Practice Address - Country:US
Practice Address - Phone:586-752-0091
Practice Address - Fax:586-677-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP30540Medicare ID - Type Unspecified