Provider Demographics
NPI:1295795839
Name:EVANS, JOHN HENRY (SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HENRY
Last Name:EVANS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LINDSAY CT
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-9007
Mailing Address - Country:US
Mailing Address - Phone:610-856-6896
Mailing Address - Fax:610-855-8068
Practice Address - Street 1:45 LINDSAY CT
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-9007
Practice Address - Country:US
Practice Address - Phone:610-856-6896
Practice Address - Fax:610-855-8068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001664L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist