Provider Demographics
NPI:1043766843
Name:JOHNER, EVELYN
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:JOHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 COPPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4633
Mailing Address - Country:US
Mailing Address - Phone:605-696-4327
Mailing Address - Fax:
Practice Address - Street 1:718 5TH ST S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3344
Practice Address - Country:US
Practice Address - Phone:605-696-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD252-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist