Individual
DR. KELLY CHARLES EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2714 STEWART AVE, WAUSAU, WI 54401-4153
(715) 849-3988
(715) 849-3988
Mailing address
2714 STEWART AVE, WAUSAU, WI 54401-4153
(715) 849-3988
(715) 849-3988
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
2027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39120800
—
WI
Enumeration date
11/01/2006
Last updated
07/08/2007
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