Healthcare Provider Details

I. General information

NPI: 1467077438
Provider Name (Legal Business Name): EVELYN L WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13257 SARATOGA LN N
CHAMPLIN MN
55316-1119
US

IV. Provider business mailing address

3300 COUNTY ROAD 10 STE 100
BROOKLYN CENTER MN
55429-3064
US

V. Phone/Fax

Practice location:
  • Phone: 763-227-3121
  • Fax:
Mailing address:
  • Phone: 763-515-9154
  • Fax: 763-999-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: