Provider Demographics
NPI:1386535516
Name:EVERSOLE, LAYNE ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:ELIZABETH
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E MATTHEWS ST APT 302
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5470
Mailing Address - Country:US
Mailing Address - Phone:540-905-5869
Mailing Address - Fax:
Practice Address - Street 1:2661 W ROOSEVELT BLVD UNIT 103
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0453
Practice Address - Country:US
Practice Address - Phone:704-523-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist