MEDICARE: EVOLUTIONS ABA, LLC

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740413301	OTHER	PA	NPI TYPE 1

General Provider Information

NPI Number	:	1942961362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTIONS ABA, LLC

Provider Business Mailing Address
First Line	:	233 SENECA ST.
Second Line	:
City	:	LESTER
State	:	PA
Zip	:	19029-1812
Country	:	US
Telephone Number	:	215-327-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 SENECA ST.
Second Line	:
City	:	LESTER
State	:	PA
Zip	:	19029-1812
Country	:	US
Telephone Number	:	215-327-4174
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA ASHBRIDGE BALAWEJDER
Credential	:	LBS, BCBA, IBA
Telephone Number	:	215-327-4174

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	05/24/2023

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Directions to “EVOLUTIONS ABA, LLC ” Practice Location

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