Provider Demographics
NPI:1134948383
Name:EVANS, LAREN RUTH
Entity type:Individual
Prefix:
First Name:LAREN
Middle Name:RUTH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 CLINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9309
Mailing Address - Country:US
Mailing Address - Phone:336-837-4797
Mailing Address - Fax:336-376-7711
Practice Address - Street 1:3796 VEST MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2912
Practice Address - Country:US
Practice Address - Phone:336-837-4797
Practice Address - Fax:336-376-7711
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist