Individual
SHANIQUA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4900 IVEY RD NW STE 1720, ACWORTH, GA 30101-4101
(770) 917-5737
Mailing address
113 VILLAGE DR, CANTON, GA 30114-8265
(912) 242-3611
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
14287550
GA
235Z00000X
Speech-Language Pathologist
Primary
SLP011253
GA
Other
Enumeration date
07/16/2021
Last updated
07/27/2021
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