Provider Demographics
NPI:1083207997
Name:EVANS, JESSA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7599
Mailing Address - Country:US
Mailing Address - Phone:785-864-4840
Mailing Address - Fax:
Practice Address - Street 1:1000 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7599
Practice Address - Country:US
Practice Address - Phone:785-864-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-154482106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician