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General NPI Number Information
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NPI Number | 1225051196
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Entity Type | Organization
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Legal Business Name | EVOLUTIONZ INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 412 NW IRVINEDALE DR
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City | ANKENY
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State | IA
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Zip | 50023-8962
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Country | US
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Telephone | 515-964-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 412 NW IRVINEDALE DR
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City | ANKENY
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State | IA
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Zip | 50023-8962
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Country | US
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Telephone | 515-964-1733
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Fax |
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | MS. LAURIE A FEIN
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Credential | LISW
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Telephone | 515-964-1733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 01501
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License Number State | IA
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