Provider Demographics
NPI:1417066036
Name:EVANS, VERLYN (SLP)
Entity Type:Individual
Prefix:DR
First Name:VERLYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-0031
Mailing Address - Country:US
Mailing Address - Phone:336-889-0077
Mailing Address - Fax:336-841-4289
Practice Address - Street 1:1700 DEEP RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2568
Practice Address - Country:US
Practice Address - Phone:336-889-0077
Practice Address - Fax:336-841-4289
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7460401Medicaid
2696790Medicare PIN