Doctor Name: | DR. TAWANA L EDGESON |
NPI Number: | 1639449911 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY. D. |
License Number: | 071007656 |
Business Practice Address: | 6502 Joliet Rd Countryside, IL - 605254682 |
Business Phone Number: | 7082158400 |
Business Fax Number: | |
Mailing Address: | 1 S 154 Eliot Lane, VILLA PARK |
State: | IL |
Postal Code: | 601810027 |
Phone Number: | 7735194279 |
Fax Number: | |
NPI Enumeration Date: | 01/04/2012 |
NPI Last Update Date: | 01/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071007656 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |