MEDICARE: KAREN G EVANS MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	001558	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205095908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN G EVANS MSW, LCSW

Provider Business Mailing Address
First Line	:	2423 N JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1937
Country	:	US
Telephone Number	:	314-531-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 N JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1937
Country	:	US
Telephone Number	:	314-531-8878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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