Provider Demographics
NPI:1790910388
Name:EVANS, ALISON MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12785 W. FOREST HILL BLVD
Mailing Address - Street 2:SUITE 8G
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4777
Mailing Address - Country:US
Mailing Address - Phone:561-753-4998
Mailing Address - Fax:561-753-4911
Practice Address - Street 1:12785 W. FOREST HILL BLVD
Practice Address - Street 2:SUITE 8G
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4777
Practice Address - Country:US
Practice Address - Phone:561-753-4998
Practice Address - Fax:561-753-4911
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist