Healthcare Provider Details

I. General information

NPI: 1255255345
Provider Name (Legal Business Name): KYLIE BREANNE EVANS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 N WALNUT RD
TURLOCK CA
95382-9539
US

IV. Provider business mailing address

2524 LESTER RD
DENAIR CA
95316-8528
US

V. Phone/Fax

Practice location:
  • Phone: 350-206-3550
  • Fax:
Mailing address:
  • Phone: 209-262-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: