Provider Demographics
NPI:1023764230
Name:CARLEEN COUTURE EVANS SPEECH-LANGUAGE PATHOLOGY INC., A PROFESSIONAL C
Entity type:Organization
Organization Name:CARLEEN COUTURE EVANS SPEECH-LANGUAGE PATHOLOGY INC., A PROFESSIONAL C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP & LACTATION EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLEEN
Authorized Official - Middle Name:COUTURE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, CLE
Authorized Official - Phone:818-293-7463
Mailing Address - Street 1:3940 LAUREL CANYON BLVD # 408
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:818-293-7463
Mailing Address - Fax:
Practice Address - Street 1:4232 AGNES AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2019
Practice Address - Country:US
Practice Address - Phone:310-463-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech