| Doctor Name: | TODD C EIDEN |
| NPI Number: | 1033142518 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 2239057 |
| Business Practice Address: | 115 E Waldo Blvd Manitowoc, WI - 54220 |
| Business Phone Number: | 9206826087 |
| Business Fax Number: | 9206825087 |
| Mailing Address: | 115 E Waldo Blvd, MANITOWOC |
| State: | WI |
| Postal Code: | 54220 |
| Phone Number: | 9206825377 |
| Fax Number: | 9206825087 |
| NPI Enumeration Date: | 07/08/2006 |
| NPI Last Update Date: | 04/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 2239057 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |