Provider Demographics
NPI:1992061568
Name:REILLY, EVELYN JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:JANE
Last Name:REILLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 COLBY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4782
Mailing Address - Country:US
Mailing Address - Phone:425-259-1366
Mailing Address - Fax:425-252-4778
Practice Address - Street 1:3525 COLBY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4782
Practice Address - Country:US
Practice Address - Phone:425-259-1366
Practice Address - Fax:425-252-4778
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60297286103G00000X
VT048.0082855103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist