Provider Demographics
NPI:1225051196
Name:EVOLUTIONZ INC
Entity Type:Organization
Organization Name:EVOLUTIONZ INC
Other - Org Name:FEIN THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-964-1733
Mailing Address - Street 1:412 NW IRVINEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8962
Mailing Address - Country:US
Mailing Address - Phone:515-964-1733
Mailing Address - Fax:
Practice Address - Street 1:412 NW IRVINEDALE DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8962
Practice Address - Country:US
Practice Address - Phone:515-964-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469148Medicaid
IAI12717Medicare ID - Type Unspecified