Provider Demographics
NPI:1851751697
Name:EASON, SALLY ANN X
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:EASON
Suffix:X
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 1:10158 VALLEY BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77078-3722
Mailing Address - Country:US
Mailing Address - Phone:832-513-9629
Mailing Address - Fax:346-444-6427
Practice Address - Street 1:10158 VALLEY BREEZE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77078-3722
Practice Address - Country:US
Practice Address - Phone:832-513-9629
Practice Address - Fax:346-444-6427
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-06
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT164683385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp