Healthcare Provider Details

I. General information

NPI: 1780292425
Provider Name (Legal Business Name): DOYLE EVANS MSW, LCSW, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 24TH ST
ROCK ISLAND IL
61201-4535
US

IV. Provider business mailing address

2104 24TH ST
ROCK ISLAND IL
61201-4535
US

V. Phone/Fax

Practice location:
  • Phone: 309-558-5529
  • Fax:
Mailing address:
  • Phone: 309-558-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008398
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020777
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: