Provider Demographics
NPI:1568129088
Name:EVANS, JENNILYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNILYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials: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:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76272-0764
Mailing Address - Country:US
Mailing Address - Phone:940-641-2194
Mailing Address - Fax:
Practice Address - Street 1:802 S LEE ST
Practice Address - Street 2:
Practice Address - City:VALLEY VIEW
Practice Address - State:TX
Practice Address - Zip Code:76272-7625
Practice Address - Country:US
Practice Address - Phone:940-665-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist