Individual
GAYLE EATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
402 OLD STATE HWY, CASCADE, ID 83611
(208) 382-4242
(208) 382-5081
Mailing address
PO BOX 1330, CASCADE, ID 83611-1330
(208) 382-4242
(208) 382-5081
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW853
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016900
REGENCE BLUE SHIELD OF ID
ID
01
—
L8539
BLUE CROSS OF ID
ID
Enumeration date
01/17/2007
Last updated
02/25/2009
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