Evans - Blake, Diane

Evans - Blake, Diane is an sole proprietor health care provider with primary practice located at 3307 Cross Winds Rd , Charlotte NC 28227-6613. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Evans - Blake, Diane can be contacted via phone (704) 668-3549.

Contact Information

Primary practice address
3307 Cross Winds Rd Charlotte NC 28227-6613
Phone: (704) 668-3549
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 1990 North Carolina

Profile Details

NPI number 1356547616
LBN Legal business name Evans - Blake, Diane
Credentials SLP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 25th, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356547616 NPPES
North Carolina MEDICAID 7411189

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