Provider Demographics
NPI:1992898571
Name:EVANS, NEIL L (PH D)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:L
Last Name:EVANS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 JAMESTOWN AVE.
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9791
Mailing Address - Country:US
Mailing Address - Phone:319-334-4823
Mailing Address - Fax:
Practice Address - Street 1:2327 JAMESTOWN AVE.
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9791
Practice Address - Country:US
Practice Address - Phone:319-334-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA117OtherPSYCHOLOGY LICENSE NUMBER
IA0109124Medicaid
IA117OtherPSYCHOLOGY LICENSE NUMBER