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NPI Code Detail

MEDICARE: MS. DONNA J EVANS M.A., CCC-SLP/L

MEDICARE: MS. DONNA J EVANS M.A., CCC-SLP/L
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
1235Z00000XSpeech-Language PathologistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
107215148OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1750361721
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DONNA J EVANS M.A., CCC-SLP/L
Provider Business Mailing Address
First Line : 2001 W WILLOW KNOLLS DR
Second Line : SUITE 106
City : PEORIA
State : IL
Zip : 61614-1290
Country : US
Telephone Number : 309-661-1350
Fax Number : 309-661-1360
Provider Business Practice Location Address
First Line : 2206 EASTLAND DR
Second Line : SUITE 306
City : BLOOMINGTON
State : IL
Zip : 61704-7742
Country : US
Telephone Number : 309-661-1350
Fax Number : 309-661-1360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 07/08/2007

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Directions to “ MS. DONNA J EVANS M.A., CCC-SLP/L” Practice Location

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