Provider Demographics
NPI:1548871379
Name:SIMMONS, EVELYN DARLENE (MSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:DARLENE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:DARLENE
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BOWENS
Mailing Address - Street 1:1414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3902
Mailing Address - Country:US
Mailing Address - Phone:708-681-4357
Mailing Address - Fax:
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3902
Practice Address - Country:US
Practice Address - Phone:708-681-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1490287101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362709982016Medicaid