Individual
MS. DIANE EVANS - BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3307 CROSS WINDS RD, CHARLOTTE, NC 28227-6613
(704) 668-3549
Mailing address
3307 CROSS WINDS RD, CHARLOTTE, NC 28227-6613
(704) 668-3549
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1990
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7411189
—
NC
Enumeration date
06/25/2007
Last updated
07/09/2007
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