Provider Demographics
NPI:1790202166
Name:HARTER, EVELYN BRITO (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:BRITO
Last Name:HARTER
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 1:4248 HERCULES RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-6318
Mailing Address - Country:US
Mailing Address - Phone:432-559-6863
Mailing Address - Fax:
Practice Address - Street 1:4248 HERCULES RD
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-6318
Practice Address - Country:US
Practice Address - Phone:432-559-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist