Provider Demographics
NPI:1528351731
Name:EVANS, KATHLEEN DAWN (MCSD-CCC/SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DAWN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MCSD-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HARDIN LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8971
Mailing Address - Country:US
Mailing Address - Phone:406-522-3701
Mailing Address - Fax:
Practice Address - Street 1:16 HARDIN LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8971
Practice Address - Country:US
Practice Address - Phone:406-522-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist