Healthcare Provider Details

I. General information

NPI: 1073659280
Provider Name (Legal Business Name): EVANSTON TOWNSHIP HIGH SCHOOL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DODGE AVE ROOM H-101
EVANSTON IL
60201-3449
US

IV. Provider business mailing address

1600 DODGE AVE ROOM H-101
EVANSTON IL
60201-3449
US

V. Phone/Fax

Practice location:
  • Phone: 847-424-7265
  • Fax: 847-492-5809
Mailing address:
  • Phone: 847-424-7265
  • Fax: 847-492-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN SWARTWOUT
Title or Position: SITE MANAGER
Credential: APN
Phone: 847-424-7265