Provider Demographics
NPI:1518686583
Name:EVANS, MOLLY ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ALEXANDRA
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 1:737 WASHINGTON DR APT 7102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-3023
Practice Address - Country:US
Practice Address - Phone:903-498-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist