Provider Demographics
NPI:1518548650
Name:EADE, OLIVIA C
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:C
Last Name:EADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HENRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6326
Mailing Address - Country:US
Mailing Address - Phone:618-610-5551
Mailing Address - Fax:618-433-8777
Practice Address - Street 1:307 HENRY ST STE 201
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6326
Practice Address - Country:US
Practice Address - Phone:618-610-5551
Practice Address - Fax:618-433-8777
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3397237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist