Provider Demographics
NPI:1609384122
Name:DENNY, EVELYN P
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:P
Last Name:DENNY
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 1:809 ANNE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9471
Mailing Address - Country:US
Mailing Address - Phone:309-621-3987
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 109
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-258-0084
Practice Address - Fax:866-319-1546
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist