Provider Demographics
NPI:1730239179
Name:EATON, LORI MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MICHELLE
Last Name:EATON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 LOVERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5117
Mailing Address - Country:US
Mailing Address - Phone:925-427-4444
Mailing Address - Fax:
Practice Address - Street 1:2351 LOVERIDGE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:925-427-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist