Provider Demographics
NPI:1467603589
Name:LACALLE, EVELYN SMITH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:SMITH
Last Name:LACALLE
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 1:410 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5310
Mailing Address - Country:US
Mailing Address - Phone:337-580-5778
Mailing Address - Fax:
Practice Address - Street 1:410 S 5TH ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5310
Practice Address - Country:US
Practice Address - Phone:337-580-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist