Provider Demographics
NPI:1679997571
Name:EVANS, JULIE (SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 N MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1919
Mailing Address - Country:US
Mailing Address - Phone:254-773-6787
Mailing Address - Fax:
Practice Address - Street 1:2170 N MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1919
Practice Address - Country:US
Practice Address - Phone:254-773-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist