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General NPI Number Information
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NPI Number | 1194183608
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Entity Type | Individual
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Provider Name | JEANNE H EVANS L.I.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 697 E BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43215-3948
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Country | US
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Telephone | 614-384-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 6450 WINCHESTER RD
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City | CARROLL
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State | OH
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Zip | 43112-9762
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Country | US
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Telephone | 740-756-4075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I2598
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License Number State | OH
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