Provider Demographics
NPI:1710794003
Name:EATON, EILEEN
Entity type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:WISHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 BARN OWL LN
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3959
Mailing Address - Country:US
Mailing Address - Phone:707-720-7412
Mailing Address - Fax:
Practice Address - Street 1:5245 CONLEY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1491
Practice Address - Country:US
Practice Address - Phone:707-386-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician