Provider Demographics
NPI:1891940680
Name:EVANS, STEPHANIE EILAND
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EILAND
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:DINSMORE
Other - Last Name:EILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:282 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5319
Mailing Address - Country:US
Mailing Address - Phone:901-729-4414
Mailing Address - Fax:
Practice Address - Street 1:282 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-5319
Practice Address - Country:US
Practice Address - Phone:901-729-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist