Healthcare Provider Details

I. General information

NPI: 1003747205
Provider Name (Legal Business Name): IRIS EVE EVINGER M.S.,SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E J ST
CHULA VISTA CA
91910-6115
US

IV. Provider business mailing address

8490 TIO DIEGO PL
LA MESA CA
91942-8457
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-8381
  • Fax:
Mailing address:
  • Phone: 619-422-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP23608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: