Provider Demographics
NPI:1073844635
Name:WHITE-SIMMONS, EVELYN SHAVON (DT)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:SHAVON
Last Name:WHITE-SIMMONS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4640
Mailing Address - Country:US
Mailing Address - Phone:815-272-4594
Mailing Address - Fax:
Practice Address - Street 1:757 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4640
Practice Address - Country:US
Practice Address - Phone:815-272-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist