Provider Demographics
NPI:1124005129
Name:EVANS, CATHERINE A (PH D)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OFFICE PARK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2587
Mailing Address - Country:US
Mailing Address - Phone:515-985-8209
Mailing Address - Fax:515-608-4405
Practice Address - Street 1:1001 OFFICE PARK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2587
Practice Address - Country:US
Practice Address - Phone:515-985-8209
Practice Address - Fax:515-608-4405
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00258103T00000X
IA00666103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124005129Medicaid
IA620003472OtherRR MEDICARE
IA1124005129Medicaid
IA1124005129Medicaid