Healthcare Provider Details

I. General information

NPI: 1679500706
Provider Name (Legal Business Name): JANELLE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELLE MARTIN

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN STREET 117A AUDIOLOGY
MARION IL
62959
US

IV. Provider business mailing address

2401 W MAIN STREET 117A AUDIOLOGY
MARION IL
62959
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax: 618-998-5656
Mailing address:
  • Phone: 618-997-5311
  • Fax: 618-998-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: