Provider Demographics
NPI:1699046516
Name:REHEARD, EVIE (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:EVIE
Middle Name:
Last Name:REHEARD
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ARGYLE RD
Mailing Address - Street 2:APT B3
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 NORRIS RD
Practice Address - Street 2:
Practice Address - City:AIRVILLE
Practice Address - State:PA
Practice Address - Zip Code:17302-9143
Practice Address - Country:US
Practice Address - Phone:717-817-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist