Provider Demographics
NPI:1184277782
Name:ROSSIN, EVIE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EVIE
Middle Name:MARIE
Last Name:ROSSIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:FREEMAN SPUR
Mailing Address - State:IL
Mailing Address - Zip Code:62841-0006
Mailing Address - Country:US
Mailing Address - Phone:618-925-1740
Mailing Address - Fax:
Practice Address - Street 1:608 ROLLIE MOORE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2351
Practice Address - Country:US
Practice Address - Phone:618-925-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0201451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical