Provider Demographics
NPI:1134934979
Name:EVANS, DESIRAE MAKIAH CHAWANN
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:MAKIAH CHAWANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-5837
Mailing Address - Country:US
Mailing Address - Phone:918-490-3423
Mailing Address - Fax:
Practice Address - Street 1:123 E 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4603
Practice Address - Country:US
Practice Address - Phone:918-938-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3952355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant