JENNIFER L EVANCY (NPI# 1154486876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154486876 |
| Entity Type | Individual |
| Full Name | JENNIFER L EVANCY |
| Credential | APSW |
| Practice Address |
800 Goold St Racine WI 53402-4567 |
| Practice Telephone | 2626382000 |
| Practice Fax Number | 2626382006 |
| Mailing Telephone | 2626382000 |
| Mailing Fax Number | 2626382006 |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2016-12-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
17601-130 | WI | Behavioral Health & Social Service Providers |
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
8650-123 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 391442732 | 05 |
| Street Address |
800 GOOLD ST |
| City | RACINE |
| State | WI |
| Zip Code | 53402-4567 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124104740 | Professional Services Group, Inc. | Counselor | 800 Goold St, Racine, WI 53402-4567 | 2006-10-27 |
| 1881085793 | Horizon Healthcare, Inc. | Psychiatry & Neurology | 800 Goold St, Racine, WI 53402-4567 | 2015-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215586847 | Jennifer Ann Wagener | Technician | 1513 Melvin Ave, Racine, WI 53402 | 2019-09-06 |
| 1023530490 | Tahir Vora | Pharmacist | 6840 Middle Rd Apt 8, Racine, WI 53402 | 2017-07-07 |
| 1154852069 | Golden Path Services | Home Health | 1700 North Main Street, Upper, Racine, WI 53402 | 2017-03-22 |
| 1376842690 | Vashir Jim Xiong | Acupuncturist | 3726 Ruby Ave, Racine, WI 53402 | 2011-03-25 |
| 1215248927 | Andrew M Asbury | Family Medicine | 2408 Four Mile Rd, Racine, WI 53402 | 2010-06-28 |
| 1215058532 | Lakeshore Family Dental Care Sc | Dentist | 3903 Douglas Ave, Racine, WI 53402 | 2007-04-03 |
| 1679626915 | David Ramon Reesman | Dentist | 3900 North Bay Dr, Racine, WI 53402 | 2007-01-19 |
| 1639286958 | Mary E Pagano | Internal Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-23 |
| 1881605111 | Caledonia Chiropractic Clinic, Sc | Chiropractor | 5401 Douglas Ave, Suite A, Racine, WI 53402 | 2006-08-11 |
| 1003923996 | David C Zablotney | Family Medicine | 5333 Douglas Ave, Racine, WI 53402 | 2006-08-24 |
| Find all providers in zip 53402 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962973479 | Karen Seif | Social Worker | 1818 Wisconsin Ave, Racine, WI 53403-2771 | 2018-12-10 |
| 1720372022 | Katie Hagen | Social Worker | 1717 Taylor Avenue, Racine, WI 53403 | 2011-06-03 |
| 1538485834 | Marianne T. Jensen | Social Worker | 2310 N Main St, Racine, WI 53402-4450 | 2010-04-12 |
| 1992916910 | Karen Carnabucci | Social Worker | 932 Lake Ave, Lake House Health & Learning Center, Racine, WI 53403-1519 | 2007-05-24 |
| 1740496868 | Linda Marie Angel | Social Worker | 420 Seventh St, Racine, WI 53403-1222 | 2007-05-15 |
| 1962525683 | Thomas Karl Galten | Social Worker | 420 7th St, Racine, WI 53403-1222 | 2007-04-09 |
| 1225191158 | Linda Susan Noer | Social Worker | 2219 Washington Ave, Racine, WI 53405-3551 | 2006-12-19 |
| 1417018664 | Angela Maria Martin | Social Worker | 6021 Durand Avenue, Suite 300, Racine, WI 53406 | 2006-12-12 |
| 1023027414 | Kathleen Fenno Mcnulty | Social Worker | 1220 Mound Ave, Suite 301, Racine, WI 53404-3350 | 2006-08-05 |
| 1457328643 | Elizabeth Hanson Will | Social Worker | 700 Villa Street, Racine, WI 53403 | 2006-03-07 |
| Find all providers in RACINE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.