Provider Demographics
NPI:1043824691
Name:EVANS, MELANIE YVONNE (MS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:YVONNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 CHENEVERT ST APT 308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4281
Mailing Address - Country:US
Mailing Address - Phone:918-231-0534
Mailing Address - Fax:
Practice Address - Street 1:3603 CHENEVERT ST APT 308
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4281
Practice Address - Country:US
Practice Address - Phone:918-231-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist