Provider Demographics
NPI:1801120795
Name:KLEIN, EVELYN R (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EVIE
Other - Middle Name:R
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8628
Mailing Address - Country:US
Mailing Address - Phone:610-291-6447
Mailing Address - Fax:
Practice Address - Street 1:24 OLD FARM LN
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8628
Practice Address - Country:US
Practice Address - Phone:610-291-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007603L103T00000X
PASL000184L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist