Individual
BLAKE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 W DUPONT RD, FORT WAYNE, IN 46825-1915
(260) 489-1774
Mailing address
13108 DENTON HL, FORT WAYNE, IN 46845-9186
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IN
Other
Enumeration date
03/17/2026
Last updated
03/17/2026
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