MEDICARE: CIDNEY JORDAN EVANSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO70107661	WA

General Provider Information

NPI Number	:	1265364632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIDNEY JORDAN EVANSON

Provider Business Mailing Address
First Line	:	921 HARVEY RD NE STE C
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-4294
Country	:	US
Telephone Number	:	253-433-1701
Fax Number	:	253-939-2867

Provider Business Practice Location Address
First Line	:	921 HARVEY RD NE STE C
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-4294
Country	:	US
Telephone Number	:	253-433-1701
Fax Number	:	253-939-2867

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ CIDNEY JORDAN EVANSON ” Practice Location

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