Roger Evenson, LCSW-44535
Social Worker, Clinical in Eagle, ID. Individual provider (NPI-1).
NPI number1164091559
StatusActive
Last updated in NPPESAug 13, 2026
Details
- NPI
- 1164091559
- Entity type
- Individual (NPI-1)
- Name
- Roger Evenson
- Credential
- LCSW-44535
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 21, 2021
- Certification date
- Aug 13, 2026
- Last updated
- Aug 13, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | LCSW-44535 | ID | Yes |
| 101YM0800X | Counselor, Mental Health | LMSW-40940 | ID |
Practice location
951 E Plaza Dr Ste 150Eagle, ID 83616-6567
Phone 208-938-2836
Mailing address
3076 N Five Mile RdBoise, ID 83713-5215
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