Everett, Ethan R
Everett, Ethan R is an individual health care provider with primary practice located at 1836 South Ave , La Crosse WI 54601-5429. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Everett, Ethan R can be contacted via phone (608) 782-7300.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 2075 | Wisconsin |
Profile Details
| NPI number | 1235123134 |
|---|---|
| LBN Legal business name | Everett, Ethan R |
| Credentials | PSYD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 7th, 2005 |
| Last updated | Apr 19th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235123134 | NPPES |
| Wisconsin | MEDICAID | 39119600 |
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