Healthcare Provider Details

I. General information

NPI: 1972811214
Provider Name (Legal Business Name): MRS. BECKY B EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 26TH ST
OGDEN UT
84401-3105
US

IV. Provider business mailing address

1327 VIA LA COSTA WAY
KAYSVILLE UT
84037-4045
US

V. Phone/Fax

Practice location:
  • Phone: 801-625-3700
  • Fax:
Mailing address:
  • Phone: 801-499-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: