Provider Demographics
NPI:1326556796
Name:EVANS, REBECCA ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2313
Mailing Address - Country:US
Mailing Address - Phone:513-847-4685
Mailing Address - Fax:513-847-4763
Practice Address - Street 1:7413 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2313
Practice Address - Country:US
Practice Address - Phone:513-847-4685
Practice Address - Fax:513-847-4763
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH1-22-63396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator