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General NPI Number Information
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NPI Number | 1699315143
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Entity Type | Individual
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Provider Name | JENNIFER IKEA EVANS LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | US ARMY MEDDAC BAVARIA PSC 411 UNIT 28037 APO, AE 091 US BAVARIA
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City | BAVARIA
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State | US BAVARIA
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Zip | 81735
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Country | DE
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Telephone | 11-496-3719
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Fax |
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Provider Business Mailing Address
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Address Line | 3012 RAMSGATE PL
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-2155
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Country | US
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Telephone | 240-640-7033
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 25593
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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