Provider Demographics
NPI:1659495943
Name:EVELYN, SEANA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SEANA
Middle Name:
Last Name:EVELYN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:SEANA
Other - Middle Name:EVELYN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S AVENUE K # 3
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7400
Mailing Address - Country:US
Mailing Address - Phone:575-562-4232
Mailing Address - Fax:
Practice Address - Street 1:1500 S AVENUE K # 3
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7400
Practice Address - Country:US
Practice Address - Phone:575-562-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP7578235Z00000X
NM3313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty