MEDICARE: EVANNA ELISE FERGUSON SLPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SLPA7377	AZ

General Provider Information

NPI Number	:	1386927762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANNA ELISE FERGUSON SLPA

Provider Business Mailing Address
First Line	:	44959 W ZION RD
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-9103
Country	:	US
Telephone Number	:	480-818-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	44480 W HONEYCUTT AVE STE 106
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2909
Country	:	US
Telephone Number	:	520-582-0142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	02/22/2026

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