Doctor Name: | DR. JANICA SUE EDWARDS |
NPI Number: | 1770948028 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P. |
License Number: | LP5973 |
Business Practice Address: | 38873 14th Ave Suite 7 North Branch, MN - 550566079 |
Business Phone Number: | 6514013064 |
Business Fax Number: | 6512515111 |
Mailing Address: | 38873 14th Ave, Suite 7 NORTH BRANCH |
State: | MN |
Postal Code: | 550566079 |
Phone Number: | 6514013064 |
Fax Number: | 6512515111 |
NPI Enumeration Date: | 12/30/2015 |
NPI Last Update Date: | 12/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP5973 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |