Healthcare Provider Details

I. General information

NPI: 1265748784
Provider Name (Legal Business Name): HEIDI HUH EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI HUH LCSW

II. Dates (important events)

Enumeration Date: 08/21/2010
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIDGE AVE 305
EVANSTON IL
60201-2455
US

IV. Provider business mailing address

5539 W EDMUNDS ST APT 3
CHICAGO IL
60630-4683
US

V. Phone/Fax

Practice location:
  • Phone: 847-440-4982
  • Fax:
Mailing address:
  • Phone: 847-707-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011644
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: