Provider Demographics
NPI:1528376241
Name:EVANS, KATHERINE BLAKESLEE (SLP, CCC/L)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BLAKESLEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP, CCC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2349
Mailing Address - Country:US
Mailing Address - Phone:716-834-7200
Mailing Address - Fax:
Practice Address - Street 1:2253 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2349
Practice Address - Country:US
Practice Address - Phone:716-834-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist