Provider Demographics
NPI:1134265036
Name:EVANS, MARGARET MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 HIGHWAY 17 BYP S
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4500
Mailing Address - Country:US
Mailing Address - Phone:828-712-1558
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4500
Practice Address - Country:US
Practice Address - Phone:843-252-0033
Practice Address - Fax:843-582-0259
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2268235Z00000X
SC8883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1295311561OtherCOMMUNICATION COTTAGE GROUP NPI
NC7411859Medicaid
SCPG0346Medicaid