MEDICARE: ALEXANDRA D 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	CSW.09924359	CO

General Provider Information

NPI Number	:	1972287928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA D EVANS

Provider Business Mailing Address
First Line	:	1496 S PIERSON ST APT 106
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1486 S PIERSON ST # 106
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6079
Country	:	US
Telephone Number	:	231-330-8876
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “ ALEXANDRA D EVANS ” Practice Location

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