Healthcare Provider Details

I. General information

NPI: 1699315143
Provider Name (Legal Business Name): JENNIFER IKEA EVANS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDDAC BAVARIA PSC 411 UNIT 28037 APO, AE 091 US BAVARIA
BAVARIA US BAVARIA
81735
DE

IV. Provider business mailing address

3012 RAMSGATE PL
FORT WASHINGTON MD
20744-2155
US

V. Phone/Fax

Practice location:
  • Phone: 11-496-3719
  • Fax:
Mailing address:
  • Phone: 240-640-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25593
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: