Individual
PHYLLIS TERRY EISENBERG II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS RN, MEED
Contact information
Practice address
250 N SUNNY SLOPE RD, SUITE 290, BROOKFIELD, WI 53005-4809
(262) 754-9460
Mailing address
PO BOX 170911, MILWAUKEE, WI 53217-8081
(414) 795-4104
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1884-125
WI
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
51189-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39790000
—
WI
Enumeration date
01/03/2007
Last updated
09/26/2008
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