Provider Demographics
NPI:1700095650
Name:CHACON, EILEEN LORRAINE (MS, MA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:LORRAINE
Last Name:CHACON
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 E BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5710
Mailing Address - Country:US
Mailing Address - Phone:520-886-9417
Mailing Address - Fax:
Practice Address - Street 1:6700 N ORACLE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7732
Practice Address - Country:US
Practice Address - Phone:520-745-5222
Practice Address - Fax:520-745-9030
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist