Provider Demographics
NPI:1750924619
Name:EVANS, KAYLYN (SLP)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S 23RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4830
Mailing Address - Country:US
Mailing Address - Phone:772-464-3303
Mailing Address - Fax:772-464-3305
Practice Address - Street 1:1801 S 23RD ST STE 2
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4830
Practice Address - Country:US
Practice Address - Phone:772-464-3303
Practice Address - Fax:772-464-3305
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist