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General NPI Number Information
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NPI Number | 1700689601
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Entity Type | Individual
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Provider Name | SARAH GRACE EVANS SLP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 13 NORTHTOWN DR STE 110
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City | JACKSON
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State | MS
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Zip | 39211-3047
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Country | US
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Telephone | 601-206-9195
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Fax | 601-206-9195
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Provider Business Mailing Address
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Address Line | 556 ACORN LN
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City | BRANDON
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State | MS
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Zip | 39047-7460
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Country | US
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Telephone | 601-320-6273
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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 | S-5202
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License Number State | MS
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