Provider Demographics
NPI:1811178189
Name:EVANS, CARLEEN (LMT)
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CARLEEN
Other - Middle Name:
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:15703 SW WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8697
Mailing Address - Country:US
Mailing Address - Phone:503-867-9387
Mailing Address - Fax:
Practice Address - Street 1:18676 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8435
Practice Address - Country:US
Practice Address - Phone:971-404-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR20620225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator