MEDICARE: EILEEN PETON-THORNTON SLP

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	235Z00000X	Speech-Language Pathologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001415008	OTHER	IL	BCBS OF IL
2	5330619	OTHER		AETNA

General Provider Information

NPI Number	:	1902954175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN PETON-THORNTON SLP

Provider Business Mailing Address
First Line	:	106 LINCOLN PLACE CT
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5884
Country	:	US
Telephone Number	:	618-236-7588
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 LINCOLN PLACE CT
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5884
Country	:	US
Telephone Number	:	618-236-7588
Fax Number	:

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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Directions to “ EILEEN PETON-THORNTON SLP” Practice Location

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