Individual provider · Type 1 NPI

Roger Evenson, LCSW-44535

Clinical Social Worker · Eagle, ID

NPI number 1164091559 Active

Practice location

951 E Plaza Dr Ste 150
Eagle, ID 83616-6567

Call (208) 938-2836 Map

Mailing address

3076 N Five Mile Rd
Boise, ID 83713-5215

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XLMSW-40940 (ID)
Clinical Social Worker Primary 1041C0700XLCSW-44535 (ID)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1164091559

Roger Evenson, LCSW-44535's National Provider Identifier is 1164091559, issued on Jun 21, 2021. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Eagle, ID. The record was last updated on Aug 13, 2026.