1881763985 NPI number — EVELYN A WEBB LCSW

Table of content: EVELYN A WEBB LCSW (NPI 1881763985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881763985 NPI number — EVELYN A WEBB LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
EVELYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881763985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 FEDERAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-872-1003
Provider Business Mailing Address Fax Number:
217-233-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 FEDERAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-872-1003
Provider Business Practice Location Address Fax Number:
217-233-4150
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  149005194 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05821971 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".