Provider Demographics
NPI:1255659793
Name:ROYAL-EVANS, CAROLINE A (MS, CCC, BC-ANCDS)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:ROYAL-EVANS
Suffix:
Gender:F
Credentials:MS, CCC, BC-ANCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 POPLAR AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:901-287-5565
Mailing Address - Fax:901-287-6804
Practice Address - Street 1:4055 N PARK LOOP
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-5042
Practice Address - Country:US
Practice Address - Phone:901-678-2009
Practice Address - Fax:901-678-5497
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist