| Doctor Name: | JEANETTE EDWARDS |
| NPI Number: | 1447490248 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 312335 |
| Business Practice Address: | 4950 Mcnutt Rd Santa Teresa, NM - 88063 |
| Business Phone Number: | 5758826200 |
| Business Fax Number: | |
| Mailing Address: | 4950 Mcnutt Rd, SANTA TERESA |
| State: | NM |
| Postal Code: | 880089621 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/06/2009 |
| NPI Last Update Date: | 03/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 312335 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |