Individual
BRUCE EISENMENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., LP
Contact information
Practice address
1751 COUNTY ROAD B W STE 100, ROSEVILLE, MN 55113-4037
(651) 255-6954
(651) 756-8914
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1882
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015029
P1
MN
01
—
106264
UC
MN
01
—
133865
CP
MN
01
—
18510
HP
MN
01
—
32Q54EI
BCBS
MN
01
—
62-01186
UBH
MN
05
—
729325900
—
MN
Enumeration date
07/19/2006
Last updated
10/19/2017
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