Evans, Kelly Charles

Evans, Kelly Charles is an sole proprietor health care provider with primary practice located at 2714 Stewart Ave , Wausau WI 54401-4153. He recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as his primary health care specialty. Evans, Kelly Charles can be contacted via phone (715) 849-3988.

Contact Information

Primary practice address
2714 Stewart Ave Wausau WI 54401-4153
Phone: (715) 849-3988
Fax: (715) 849-3988
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X 2027 Wisconsin

Profile Details

NPI number 1720165251
LBN Legal business name Evans, Kelly Charles
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Jul 8th, 2007 - about 17 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 1720165251 NPPES
Wisconsin MEDICAID 39120800

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