Provider Demographics
NPI:1114219193
Name:EAGON, ELIZABETH E (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:EAGON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ELLEN
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:787 WEATHERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8949
Practice Address - Country:US
Practice Address - Phone:931-647-1255
Practice Address - Fax:931-647-2399
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001259231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525013Medicaid
TN6091991OtherBCBS TN