Provider Demographics
NPI:1801224449
Name:C R ECCLESTON THERAPY LLC
Entity Type:Organization
Organization Name:C R ECCLESTON THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ECCLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-705-6055
Mailing Address - Street 1:240 LILLIAN DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 LILLIAN DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2058
Practice Address - Country:US
Practice Address - Phone:740-705-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty