Seybold, Eric D

Seybold, Eric D is an individual health care provider with primary practice located at 12690 W North Ave , Brookfield WI 53005-4636. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Seybold, Eric D can be contacted via phone (262) 785-1008.

Contact Information

Primary practice address
12690 W North Ave Brookfield WI 53005-4636
Phone: (262) 785-1008
Fax: (262) 785-0644
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2494-057 Wisconsin

Profile Details

NPI number 1427002211
LBN Legal business name Seybold, Eric D
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated Jan 15th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427002211 NPPES
Wisconsin MEDICAID 39769500

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