MEDICARE: MRS. NATALIE JONES EVANS M.S.,CCC- SLP

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	235Z00000X	Speech-Language Pathologist	105978	TX

General Provider Information

NPI Number	:	1538458872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE JONES EVANS M.S.,CCC- SLP

Provider Business Mailing Address
First Line	:	309 N GALLOWAY AVE
Second Line	:	SUITE 110
City	:	MESQUITE
State	:	TX
Zip	:	75149-4364
Country	:	US
Telephone Number	:	214-988-5437
Fax Number	:	800-921-7173

Provider Business Practice Location Address
First Line	:	309 N GALLOWAY AVE
Second Line	:	SUITE 110
City	:	MESQUITE
State	:	TX
Zip	:	75149-4364
Country	:	US
Telephone Number	:	214-988-5437
Fax Number	:	800-921-7173

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	06/19/2012

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