Provider Demographics
NPI:1205347796
Name:RUNYAN, ELEANOR (SLP)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 145
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44687
Mailing Address - Country:US
Mailing Address - Phone:330-893-2213
Mailing Address - Fax:
Practice Address - Street 1:WALNUT CREEK ELEMENTARY SCHOOL
Practice Address - Street 2:4840 OLDE PUMP ST
Practice Address - City:WALNUT CREEK
Practice Address - State:OH
Practice Address - Zip Code:44687
Practice Address - Country:US
Practice Address - Phone:330-893-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-1508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist