Provider Demographics
NPI:1376133876
Name:EVANS, CARLEEN COUTURE
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:COUTURE
Last Name:EVANS
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 1:4232 AGNES AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2019
Mailing Address - Country:US
Mailing Address - Phone:310-463-4303
Mailing Address - Fax:
Practice Address - Street 1:4232 AGNES AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2019
Practice Address - Country:US
Practice Address - Phone:310-463-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist