Individual
MS. NICOLE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2411 W CONGRESS PKWY, CHICAGO, IL 60612
(773) 777-7112
Mailing address
401 W SPRINGFIELD AVE, CHAMPAIGN, IL 61820-4716
(217) 398-8464
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363297629
—
IL
Enumeration date
07/08/2015
Last updated
08/02/2018
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