Provider Demographics
NPI:1003183310
Name:EVANS, CARLY (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:
Last Name:EVANS
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 1:4725 RIVERHORSE DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8222
Mailing Address - Country:US
Mailing Address - Phone:605-212-8782
Mailing Address - Fax:
Practice Address - Street 1:4741 TROUSDALE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1332
Practice Address - Country:US
Practice Address - Phone:615-290-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD667-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist