MEDICARE: MRS. PRINCESS EVANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	04750	MD

General Provider Information

NPI Number	:	1649688227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRINCESS EVANS

Provider Business Mailing Address
First Line	:	7103 SEQUOIA TER
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-1462
Country	:	US
Telephone Number	:	301-807-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	7103 SEQUOIA TER
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-1462
Country	:	US
Telephone Number	:	301-807-4821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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Directions to “ MRS. PRINCESS EVANS ” Practice Location

Language	Start Address	Practice Location

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