Healthcare Provider Details

I. General information

NPI: 1881526010
Provider Name (Legal Business Name): MCKENNA EVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 CIRCLE DR
HOLMEN WI
54636-9187
US

IV. Provider business mailing address

W3992 BOSTWICK LN
WEST SALEM WI
54669-9139
US

V. Phone/Fax

Practice location:
  • Phone: 608-413-4825
  • Fax:
Mailing address:
  • Phone: 414-666-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: