Basic Information
| Provider Information | |||||||||
| NPI: | 1740634559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERS | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.I.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 W ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546155052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152845361 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 711 W ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546155052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152845361 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 22387 | MN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 20922-875 | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.