Evancy, Jennifer L

Evancy, Jennifer L is an individual health care provider with primary practice located at 800 Goold St , Racine WI 53402-4567. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Evancy, Jennifer L can be contacted via phone (262) 638-2000.

Contact Information

Primary practice address
800 Goold St Racine WI 53402-4567
Phone: (262) 638-2000
Fax: (262) 638-2006
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 8650-123 Wisconsin
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 17601-130 Wisconsin

Profile Details

NPI number 1154486876
LBN Legal business name Evancy, Jennifer L
Credentials APSW
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 22nd, 2006
Last updated Dec 12th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154486876 NPPES
Wisconsin MEDICAID 391442732

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