Provider Demographics
NPI:1285879312
Name:EVANS, GAIL MARIE (CCC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5426
Mailing Address - Country:US
Mailing Address - Phone:918-742-7376
Mailing Address - Fax:918-743-2117
Practice Address - Street 1:1725 E 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5426
Practice Address - Country:US
Practice Address - Phone:918-742-7376
Practice Address - Fax:918-743-2117
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100659530 AMedicaid