Provider Demographics
NPI:1265668966
Name:BEVINS, CARLA A (MS CCC S/LP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:BEVINS
Suffix:
Gender:F
Credentials:MS CCC S/LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21115 HUNTER HILL DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-1313
Mailing Address - Country:US
Mailing Address - Phone:352-583-3245
Mailing Address - Fax:
Practice Address - Street 1:21115 HUNTER HILL DR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-1313
Practice Address - Country:US
Practice Address - Phone:352-583-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist