MEDICARE: RYLEE EVANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11860150-3502	UT

General Provider Information

NPI Number	:	1780535963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLEE EVANS

Provider Business Mailing Address
First Line	:	7414 S STATE ST
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7414 S STATE ST
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-5675
Country	:	US
Telephone Number	:	801-265-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	06/04/2026

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Directions to “ RYLEE EVANS ” Practice Location

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