Provider Demographics
NPI:1073716718
Name:EDWARDS, JENNIFER LYNN (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 RANCH ROAD 620 N
Mailing Address - Street 2:#1106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4200
Mailing Address - Country:US
Mailing Address - Phone:512-215-0463
Mailing Address - Fax:
Practice Address - Street 1:9009 RANCH ROAD 620 N
Practice Address - Street 2:#1106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4200
Practice Address - Country:US
Practice Address - Phone:512-215-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator