Individual
CHASE GARDNER EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SSW
Contact information
Practice address
475 W 260 N, OREM, UT 84057-1970
(801) 221-9930
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396085718
—
UT
Enumeration date
09/04/2019
Last updated
09/15/2023
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