Provider Demographics
NPI:1538291984
Name:EVANS, JUDY (SLP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1083
Mailing Address - Country:US
Mailing Address - Phone:870-777-6955
Mailing Address - Fax:
Practice Address - Street 1:5954 HWY 29 NORTH
Practice Address - Street 2:
Practice Address - City:BLEVINS
Practice Address - State:AR
Practice Address - Zip Code:71825
Practice Address - Country:US
Practice Address - Phone:870-777-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist