Provider Demographics
NPI:1013435767
Name:TOONSTRA, EVAN HANS (LGSW)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:HANS
Last Name:TOONSTRA
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELIZABETH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2641
Mailing Address - Country:US
Mailing Address - Phone:218-259-7780
Mailing Address - Fax:
Practice Address - Street 1:115 7TH ST
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1528
Practice Address - Country:US
Practice Address - Phone:218-834-6005
Practice Address - Fax:218-595-1004
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN265251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical