Provider Demographics
NPI:1568962405
Name:EDWARDS, JANET EILEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:EILEEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19091 COOK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-9698
Mailing Address - Country:US
Mailing Address - Phone:360-421-2741
Mailing Address - Fax:
Practice Address - Street 1:203 W HOLLY ST STE 320
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4329
Practice Address - Country:US
Practice Address - Phone:360-421-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607297431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical