Healthcare Provider Details

I. General information

NPI: 1306490651
Provider Name (Legal Business Name): BRIDGETTE ELAINE EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGETTE ADKINS

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S CHECK ST STE 110
WASILLA AK
99654-8067
US

IV. Provider business mailing address

401 N MAIN ST 870630
WASILLA AK
99687
US

V. Phone/Fax

Practice location:
  • Phone: 912-318-2329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number195464
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1735622
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: