Provider Demographics
NPI:1063579241
Name:EITEN, LEISHA R (AUD)
Entity type:Individual
Prefix:MS
First Name:LEISHA
Middle Name:R
Last Name:EITEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:402-498-6540
Practice Address - Fax:402-498-6357
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE122231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2588277Medicaid
IA9588269Medicaid
IA3588269Medicaid
IA4588269Medicaid
IA0588277Medicaid
IA1588277Medicaid
IA3588277Medicaid
IA5588269Medicaid
IA8588269Medicaid
NE36819OtherBCBS ENT
NE36818OtherBCBS BT
IA7588269Medicaid
IA0588269Medicaid
IA1588269Medicaid
IA2588269Medicaid
IA3588277Medicaid
IA5588269Medicaid
IA0588277Medicaid