Provider Demographics
NPI:1164874293
Name:EVERSON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:EVERSON
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 1:5412 S WHISPER COVE TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3707
Mailing Address - Country:US
Mailing Address - Phone:605-359-9116
Mailing Address - Fax:
Practice Address - Street 1:715 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5151
Practice Address - Country:US
Practice Address - Phone:605-367-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD601-PROV235Z00000X
SD686-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist