Provider Demographics
NPI:1528112919
Name:EVANS, MINNIE JEAN (MA)
Entity type:Individual
Prefix:MRS
First Name:MINNIE
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 LARIAT DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3040
Mailing Address - Country:US
Mailing Address - Phone:314-521-2186
Mailing Address - Fax:314-521-0816
Practice Address - Street 1:8414 LARIAT DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3040
Practice Address - Country:US
Practice Address - Phone:314-521-2186
Practice Address - Fax:314-521-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist