Healthcare Provider Details

I. General information

NPI: 1124675699
Provider Name (Legal Business Name): EVELYN BEARDSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 COLUMBIA AVE
MERCED CA
95340-0921
US

IV. Provider business mailing address

734 COLUMBIA AVE
MERCED CA
95340-0921
US

V. Phone/Fax

Practice location:
  • Phone: 310-844-8265
  • Fax:
Mailing address:
  • Phone: 209-259-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: