Provider Demographics
NPI:1801140959
Name:EVANS, MARA ANN (MS CCC)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 235TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4458
Mailing Address - Country:US
Mailing Address - Phone:425-868-3626
Mailing Address - Fax:425-868-1519
Practice Address - Street 1:1010 S 336TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6385
Practice Address - Country:US
Practice Address - Phone:866-835-7102
Practice Address - Fax:888-835-7102
Is Sole Proprietor?:No
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist