Individual
CODY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 MAPLE ST STE A103A109, FLORENCE, CO 81226-1443
(541) 761-6230
Mailing address
6874 S ULSTER CIR, CENTENNIAL, CO 80112-1364
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-138548
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-20-138548
BACB
—
Enumeration date
10/06/2020
Last updated
10/06/2020
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