Provider Demographics
NPI:1609901024
Name:EVANS, EVAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:L
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:1343 A MONMOUTH ST
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-0248
Mailing Address - Country:US
Mailing Address - Phone:503-838-3001
Mailing Address - Fax:503-838-0994
Practice Address - Street 1:1343 A MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-0248
Practice Address - Country:US
Practice Address - Phone:503-838-3001
Practice Address - Fax:503-838-0994
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP119476237700000X
OR30205231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229575Medicaid
OR229575Medicaid