Provider Demographics
NPI:1992314777
Name:EGGLESTON, OLIVIA MERCEDES (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MERCEDES
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 11TH AVE N APT 213
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3640
Mailing Address - Country:US
Mailing Address - Phone:831-269-9106
Mailing Address - Fax:
Practice Address - Street 1:4741 TROUSDALE DR STE 1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1340
Practice Address - Country:US
Practice Address - Phone:615-290-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TN7174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist