Provider Demographics
NPI:1811576044
Name:WITTING, EVELYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:WITTING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 CHEEK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4949
Mailing Address - Country:US
Mailing Address - Phone:919-215-2737
Mailing Address - Fax:
Practice Address - Street 1:65 MCCACHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3532
Practice Address - Country:US
Practice Address - Phone:704-788-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17979235Z00000X
CA31472235Z00000X
NC14263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist