Provider Demographics
NPI:1790796191
Name:EVANS, YOLANDA T (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:T
Last Name:EVANS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56706
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3706
Mailing Address - Country:US
Mailing Address - Phone:901-795-6983
Mailing Address - Fax:
Practice Address - Street 1:3750 LINDELL BLVD
Practice Address - Street 2:13
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3412
Practice Address - Country:US
Practice Address - Phone:314-977-2480
Practice Address - Fax:314-977-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000001215OtherLICENSE
MO2008022569OtherSTATE LICENSE