Healthcare Provider Details

I. General information

NPI: 1023352515
Provider Name (Legal Business Name): CHELEE J EATON M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 PINEBROOK RD.
VENICE FL
34285
US

IV. Provider business mailing address

2124 SUNNYSIDE LN
SARASOTA FL
34239-4601
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-6733
  • Fax:
Mailing address:
  • Phone: 941-362-4762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 6531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: