Provider Demographics
NPI:1497302376
Name:RENDON, EVY NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EVY
Middle Name:NICOLE
Last Name:RENDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 LARKSPUR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3846
Mailing Address - Country:US
Mailing Address - Phone:956-827-6596
Mailing Address - Fax:956-271-1533
Practice Address - Street 1:8115 N LOS EBANOS RD STE 4
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1670
Practice Address - Country:US
Practice Address - Phone:956-271-1535
Practice Address - Fax:956-271-1533
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist