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General NPI Number Information
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NPI Number | 1033767140
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Entity Type | Individual
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Provider Name | KACIE EVANS
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Gender | Female
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Dates
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Enumeration Date | 09/01/2019
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 1191 OLD LORENA RD
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City | LORENA
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State | TX
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Zip | 76655-3176
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Country | US
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Telephone | 817-914-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 PURDUE DR
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City | ARLINGTON
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State | TX
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Zip | 76012-5346
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Country | US
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Telephone | 817-914-6670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 113509
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License Number State | TX
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