Provider Demographics
NPI:1942535588
Name:EVANS-WILLIAMS, JEAN FAYE (MSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:FAYE
Last Name:EVANS-WILLIAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 THIRD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020
Mailing Address - Country:US
Mailing Address - Phone:715-755-2233
Mailing Address - Fax:715-755-3966
Practice Address - Street 1:204 THIRD AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-0817
Practice Address - Country:US
Practice Address - Phone:715-755-2233
Practice Address - Fax:715-755-3966
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2031-1211041C0700X
MN1336111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical