Provider Demographics
NPI:1871860635
Name:BERTOLINO-EATON, DANEEN BEA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANEEN
Middle Name:BEA
Last Name:BERTOLINO-EATON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:DANEEN
Other - Middle Name:BEA
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:113 MOOSE TRACKS DR
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070
Mailing Address - Country:US
Mailing Address - Phone:406-425-1042
Mailing Address - Fax:406-545-2319
Practice Address - Street 1:113 MOOSE TRACKS DR
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:MT
Practice Address - Zip Code:59070
Practice Address - Country:US
Practice Address - Phone:406-425-1042
Practice Address - Fax:406-545-2319
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist