Organization
JESSICA EVANS CCC-SLP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA EVANS (PRESIDENT)
(786) 877-5679
Entity
Organization
Contact information
Practice address
1725 BOSTON ST SE, GRAND RAPIDS, MI 49506-4461
(786) 877-5679
Mailing address
1725 BOSTON ST SE, GRAND RAPIDS, MI 49506-4461
(786) 877-5679
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101000969
MI
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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