Provider Demographics
NPI:1366914608
Name:EVICH, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:EVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 SHOOFLY PATH
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1982
Mailing Address - Country:US
Mailing Address - Phone:321-287-4684
Mailing Address - Fax:919-367-6154
Practice Address - Street 1:917 SHOOFLY PATH
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1982
Practice Address - Country:US
Practice Address - Phone:321-287-4684
Practice Address - Fax:919-367-6154
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist