Provider Demographics
NPI:1285114025
Name:EATON, JENNIFER (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. MAXWELL ST.
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448
Mailing Address - Country:US
Mailing Address - Phone:618-783-8464
Mailing Address - Fax:
Practice Address - Street 1:100 E. MAXWELL ST.
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448
Practice Address - Country:US
Practice Address - Phone:618-783-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL239258OtherIEIN
1427725OtherASHA
IL242.004814OtherSTATE OF IL
IL1268707OtherILLINOIS SPEECH LANGUAGE HEARING ASSOCIATION