Individual
JERRELL EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
259 E 115TH ST, CHICAGO, IL 60628-5014
(773) 493-4100
Mailing address
259 E 115TH ST, CHICAGO, IL 60628-5014
(773) 493-4100
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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