| Evergreen Therapy Center Llc | |
|
2140 Norcor Ave Ste 103 Coralville IA 52241-9736 | |
| (319) 853-8762 | |
| Not Available |
| Full Name | Evergreen Therapy Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2140 Norcor Ave Ste 103, Coralville, Iowa |
| Authorized Official Name and Position | Jason Drwal (OWNER) |
| Authorized Official Contact | 3198538762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Therapy Center Llc 144 Lockmoor Cir North Liberty IA 52317-8042 Ph: (319) 853-8762 | Evergreen Therapy Center Llc 2140 Norcor Ave Ste 103 Coralville IA 52241-9736 Ph: (319) 853-8762 |
| NPI Number | 1043828825 |
|---|---|
| Provider Enumeration Date | 07/17/2020 |
| Last Update Date | 07/17/2020 |
| Certification Date | 07/17/2020 |
| Medicare PECOS PAC ID | 8527465863 |
|---|---|
| Medicare Enrollment ID | O20210929000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043828825 | NPI | - | NPPES |
| Provider Name | Mallory R Markwitz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902446305 PECOS PAC ID: 0345677225 Enrollment ID: I20200305002980 |
| Provider Name | Natalie A Quinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982111761 PECOS PAC ID: 7810311305 Enrollment ID: I20200716001915 |
| Provider Name | Jason Matthew Drwal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164669594 PECOS PAC ID: 9436556776 Enrollment ID: I20210929000717 |
| Provider Name | Julie Easton Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619516960 PECOS PAC ID: 0749610020 Enrollment ID: I20220707003103 |
| Provider Name | Jaci Rolffs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497274260 PECOS PAC ID: 7517300395 Enrollment ID: I20240208002298 |
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