Provider Demographics
NPI:1386927762
Name:FERGUSON, EVANNA ELISE (SLPA)
Entity type:Individual
Prefix:
First Name:EVANNA
Middle Name:ELISE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44959 W ZION RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-9103
Mailing Address - Country:US
Mailing Address - Phone:480-818-2193
Mailing Address - Fax:
Practice Address - Street 1:44480 W HONEYCUTT AVE STE 106
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2909
Practice Address - Country:US
Practice Address - Phone:520-582-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA73772355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant