Provider Demographics
NPI:1750993044
Name:MENDEZ, EVELYN EDITH (BS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:EDITH
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W LA JOLLA DR APT 1018
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4433
Mailing Address - Country:US
Mailing Address - Phone:928-323-7407
Mailing Address - Fax:
Practice Address - Street 1:1600 W LA JOLLA DR APT 1018
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4433
Practice Address - Country:US
Practice Address - Phone:928-323-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-20-131451106S00000X
AZSLPA131342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician