Healthcare Provider Details

I. General information

NPI: 1821932468
Provider Name (Legal Business Name): ERIC FREMONT EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 BEECH ST
NORMAL IL
61761-5622
US

IV. Provider business mailing address

1718 BEECH ST
NORMAL IL
61761-5622
US

V. Phone/Fax

Practice location:
  • Phone: 309-826-7844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: