MEDICARE: CARLEY EASON EVANS MS CCCSLP

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	1523	SC

General Provider Information

NPI Number	:	1801887468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY EASON EVANS MS CCCSLP

Provider Business Mailing Address
First Line	:	169 ASHLEY AVE
Second Line	:	MSC 335
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-876-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 ASHLEY AVE
Second Line	:	MSC 335
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-876-7200
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/14/2011

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