| Doctor Name: | SANDRA L EICKMANN |
| NPI Number: | 1013073642 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, MPH, LPC |
| License Number: | LPC.0011233 |
| Business Practice Address: | 1515 Diamond Wall Dr Berthoud, CO - 805138449 |
| Business Phone Number: | 9704608477 |
| Business Fax Number: | 9704607226 |
| Mailing Address: | 1515 Diamond Wall Dr, BERTHOUD |
| State: | CO |
| Postal Code: | 805138449 |
| Phone Number: | 9704608477 |
| Fax Number: | 9704607226 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 09/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC.0011233 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |