MEDICARE: EMILY EVANS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	156F00000X	Technician/Technologist
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1740786292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY EVANS

Provider Business Mailing Address
First Line	:	10751 S SAGINAW ST STE E
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10751 S SAGINAW ST STE E
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8169
Country	:	US
Telephone Number	:	907-378-4096
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/05/2024

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Directions to “ EMILY EVANS ” Practice Location

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