Provider Demographics
NPI:1699209171
Name:EVANS, JOYCE (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 W C ST
Mailing Address - Street 2:3110 E C ST
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1604
Mailing Address - Country:US
Mailing Address - Phone:307-532-7068
Mailing Address - Fax:
Practice Address - Street 1:126 N WYOMING AV
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214-0100
Practice Address - Country:US
Practice Address - Phone:307-836-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist