Provider Demographics
NPI:1306078605
Name:EVANS, COLLEEN SUSAN (MSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:SUSAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 12TH ST
Mailing Address - Street 2:SUITE 4710
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1004
Mailing Address - Country:US
Mailing Address - Phone:612-348-2051
Mailing Address - Fax:612-466-9621
Practice Address - Street 1:330 S 12TH ST
Practice Address - Street 2:SUITE 4710
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1004
Practice Address - Country:US
Practice Address - Phone:612-348-2051
Practice Address - Fax:612-466-9621
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker