Individual
MS. MARIAN ECKHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
8025 34TH PL N, CRYSTAL, MN 55427-1926
(612) 393-7885
(763) 546-8577
Mailing address
8025 34TH PL N, CRYSTAL, MN 55427-1926
(612) 393-7885
(763) 546-8577
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
LP5175
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124244785
—
MN
01
—
680002860
MEDICARE PTAN
—
Enumeration date
04/18/2007
Last updated
05/24/2022
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