Provider Demographics
NPI:1487992533
Name:EVANS, KRISTEN N (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:N
Last Name:EVANS
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 1:4328 BLAND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6125
Mailing Address - Country:US
Mailing Address - Phone:919-981-6588
Mailing Address - Fax:919-981-6255
Practice Address - Street 1:4328 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6125
Practice Address - Country:US
Practice Address - Phone:919-981-6588
Practice Address - Fax:919-981-6255
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist