Provider Demographics
NPI:1063607570
Name:EVANS, RENEE VANESSA (SLP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:VANESSA
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 DORSET CT
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8133
Mailing Address - Country:US
Mailing Address - Phone:215-504-0858
Mailing Address - Fax:215-504-0858
Practice Address - Street 1:189 DORSET CT
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8133
Practice Address - Country:US
Practice Address - Phone:215-504-0858
Practice Address - Fax:215-504-0858
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004670L235Z00000X
NJ41YS00287500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist