Provider Demographics
NPI:1649363441
Name:EVANS, BEVERLYN H (MCD,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BEVERLYN
Middle Name:H
Last Name:EVANS
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:BEVERLYN
Other - Middle Name:H
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCD,CCC-SLP
Mailing Address - Street 1:104 TALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3083
Mailing Address - Country:US
Mailing Address - Phone:864-261-4033
Mailing Address - Fax:
Practice Address - Street 1:104 TALLEY CT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3083
Practice Address - Country:US
Practice Address - Phone:864-617-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist