Provider Demographics
NPI:1962912980
Name:EVANS, ELLIZABETH
Entity type:Individual
Prefix:
First Name:ELLIZABETH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 S WOOD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-0011
Mailing Address - Country:US
Mailing Address - Phone:773-699-1099
Mailing Address - Fax:
Practice Address - Street 1:8201 CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5314
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:630-590-5731
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst