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General NPI Number Information
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NPI Number | 1023177201
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Entity Type | Individual
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Provider Name | BARRY LEROY EVANS MASTER SOCIAL WORK
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1125 6TH STREET SE WOODLAND CENTERS
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City | WILLMAR
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State | MN
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Zip | 56201-4675
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Country | US
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Telephone | 320-231-9148
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Fax | 320-231-9140
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Provider Business Mailing Address
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Address Line | 5285 COUNTY ROAD 4 NE
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City | ATWATER
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State | MN
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Zip | 56209
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Country | US
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Telephone | 320-235-4613
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Fax | 320-231-9140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 391
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License Number State | MN
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