Provider Demographics
NPI:1801887468
Name:EVANS, CARLEY EASON (MS CCCSLP)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:EASON
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:VALERIE
Other - Last Name:EVANS KREIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCSLP
Mailing Address - Street 1:169 ASHLEY AVE
Mailing Address - Street 2:MSC 335
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:843-876-7200
Mailing Address - Fax:
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:MSC 335
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8905
Practice Address - Country:US
Practice Address - Phone:843-876-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist