Provider Demographics
NPI:1376770479
Name:EILERS, ALEISIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEISIA
Middle Name:
Last Name:EILERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MEMORIAL DR
Mailing Address - Street 2:MEDICAL OFFICE BUILDING # 3, SUITE 150
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5373
Mailing Address - Country:US
Mailing Address - Phone:618-767-3906
Mailing Address - Fax:618-257-6960
Practice Address - Street 1:4700 MEMORIAL DR
Practice Address - Street 2:MEDICAL OFFICE BUILDING # 3, SUITE 150
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-767-3906
Practice Address - Fax:618-257-6960
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist