Provider Demographics
NPI:1811478530
Name:EATON, JOSIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15261 N MOUZIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47561-8301
Mailing Address - Country:US
Mailing Address - Phone:812-830-8764
Mailing Address - Fax:
Practice Address - Street 1:15261 N MOUZIN RD
Practice Address - Street 2:
Practice Address - City:OAKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47561-8301
Practice Address - Country:US
Practice Address - Phone:812-830-8764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006798A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22006798AOtherLICENSE NUMBER