Provider Demographics
NPI:1972393569
Name:EVANS, LADENNA ALICE
Entity type:Individual
Prefix:
First Name:LADENNA
Middle Name:ALICE
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PIVOT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9506
Mailing Address - Country:US
Mailing Address - Phone:918-864-1508
Mailing Address - Fax:
Practice Address - Street 1:29 PIVOT ROCK RD
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9506
Practice Address - Country:US
Practice Address - Phone:918-864-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician