MEDICARE: DANA LEE ECKONEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265922769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LEE ECKONEN

Provider Business Mailing Address
First Line	:	621 S ERIE HWY
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-4315
Country	:	US
Telephone Number	:	513-795-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 WILLIAMS ST
Second Line	:
City	:	LOCKLAND
State	:	OH
Zip	:	45215-4601
Country	:	US
Telephone Number	:	513-827-6281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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Directions to “ DANA LEE ECKONEN ” Practice Location

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