Provider Demographics
NPI:1912567264
Name:HARRISON EALES, ALENA MARIE
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:MARIE
Last Name:HARRISON EALES
Suffix:
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 1:814 N GAMMON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1149
Mailing Address - Country:US
Mailing Address - Phone:608-695-6705
Mailing Address - Fax:
Practice Address - Street 1:814 N GAMMON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1149
Practice Address - Country:US
Practice Address - Phone:608-695-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist