Basic Information
Provider Information
NPI: 1003013376
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EVANS
FirstName: SHEILA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.S., CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2304 E DELAWARE ST
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477115936
CountryCode: US
TelephoneNumber: 8127600709
FaxNumber:  
Practice Location
Address1: 1425 S WEINBACH AVE
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477142931
CountryCode: US
TelephoneNumber: 8127600709
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 06/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X163605KYY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
235Z00000X22003533AINN Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
1250192005KY MEDICAID


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