Provider Demographics
NPI:1043568140
Name:EDGERSON, ANNIKA NICHOLE
Entity Type:Individual
Prefix:
First Name:ANNIKA
Middle Name:NICHOLE
Last Name:EDGERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3634
Mailing Address - Country:US
Mailing Address - Phone:860-752-3081
Mailing Address - Fax:
Practice Address - Street 1:30 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3634
Practice Address - Country:US
Practice Address - Phone:860-752-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker