Provider Demographics
NPI:1073009882
Name:BERTOLOTTI, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BERTOLOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1802
Mailing Address - Country:US
Mailing Address - Phone:815-274-9441
Mailing Address - Fax:
Practice Address - Street 1:3781 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-6047
Practice Address - Country:US
Practice Address - Phone:815-274-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health