Provider Demographics
NPI:1548159304
Name:EVANGELISTA, AMY ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31098 OAKLEAF LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1262
Mailing Address - Country:US
Mailing Address - Phone:248-790-6884
Mailing Address - Fax:
Practice Address - Street 1:31098 OAKLEAF LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1262
Practice Address - Country:US
Practice Address - Phone:248-790-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist