Provider Demographics
NPI:1902963671
Name:EVANS, SUSAN ETHEL (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ETHEL
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 ORONDO AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2828
Mailing Address - Country:US
Mailing Address - Phone:509-662-7632
Mailing Address - Fax:509-662-3919
Practice Address - Street 1:434 ORONDO AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2828
Practice Address - Country:US
Practice Address - Phone:509-662-7632
Practice Address - Fax:509-662-3919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000041051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical