Provider Demographics
NPI:1851854608
Name:EATON, SARA (MSP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:481 RIVER BEND RD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5285
Mailing Address - Country:US
Mailing Address - Phone:630-881-4447
Mailing Address - Fax:
Practice Address - Street 1:2S700 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1456
Practice Address - Country:US
Practice Address - Phone:630-393-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL34917742Medicaid