MEDICARE: ASHANTI EVANS

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	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1386497550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHANTI EVANS

Provider Business Mailing Address
First Line	:	PO BOX 243
Second Line	:
City	:	SUGAR GROVE
State	:	OH
Zip	:	43155-0243
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 E MAIN ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3808
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	09/03/2024

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Directions to “ ASHANTI EVANS ” Practice Location

Language	Start Address	Practice Location

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