Provider Demographics
NPI:1679669071
Name:ELIASON, ERIC ALAN (CCC-A)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALAN
Last Name:ELIASON
Suffix:
Gender:M
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 KEILY STREET
Mailing Address - Street 2:CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORATE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212
Mailing Address - Country:US
Mailing Address - Phone:757-953-7550
Mailing Address - Fax:757-953-7560
Practice Address - Street 1:554 KEILY STREET
Practice Address - Street 2:CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORATE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-8014
Practice Address - Country:US
Practice Address - Phone:757-953-7550
Practice Address - Fax:757-953-7560
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80203231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist