Healthcare Provider Details

I. General information

NPI: 1003318502
Provider Name (Legal Business Name): ELISABETH KATHRYN EVANS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 E INDIANA AVE STE 3400
SPOKANE VALLEY WA
99216-2830
US

IV. Provider business mailing address

340 W SUNSET WAY APT A202
ISSAQUAH WA
98027-3159
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-6421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33644
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: