Provider Demographics
NPI:1083909436
Name:EDWARDS, AUSTIN JARRETT
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:JARRETT
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 N OBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4456
Mailing Address - Country:US
Mailing Address - Phone:503-333-4808
Mailing Address - Fax:
Practice Address - Street 1:1508 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3312
Practice Address - Country:US
Practice Address - Phone:503-597-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker