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Individual

MS. VICKI LEE EATON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
825 W JEROME CIR, MESA, AZ 85210-5939
(847) 849-7140
Mailing address
825 W JEROME CIR, MESA, AZ 85210-5939
(847) 849-7140

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-005721
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01626654
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/08/2006
Last updated
04/08/2020
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