Provider Demographics
NPI:1518179902
Name:EVANS, DENISE GALE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:GALE
Last Name:EVANS
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 GUILLOT RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0488
Mailing Address - Country:US
Mailing Address - Phone:337-369-7925
Mailing Address - Fax:
Practice Address - Street 1:208 SWEETWATER RIM
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5691
Practice Address - Country:US
Practice Address - Phone:318-888-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist