Healthcare Provider Details

I. General information

NPI: 1811178189
Provider Name (Legal Business Name): CARLEEN EVANS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLEEN ASHTON LMT

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18676 SW BOONES FERRY RD
TUALATIN OR
97062-8435
US

IV. Provider business mailing address

15703 SW WILLOW CT
SHERWOOD OR
97140-8697
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-1736
  • Fax:
Mailing address:
  • Phone: 503-867-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20620
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: