Provider Demographics
NPI:1750361721
Name:EVANS, DONNA J (MA, CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:EVANS
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Gender:F
Credentials:MA, CCC-SLP/L
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Mailing Address - Street 1:2001 W WILLOW KNOLLS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1290
Mailing Address - Country:US
Mailing Address - Phone:309-661-1350
Mailing Address - Fax:309-661-1360
Practice Address - Street 1:2206 EASTLAND DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7742
Practice Address - Country:US
Practice Address - Phone:309-661-1350
Practice Address - Fax:309-661-1360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07215148OtherBLUE CROSS BLUE SHIELD