Provider Demographics
NPI:1689604548
Name:EDWARDS, JUDITH M (LSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:M
Other - Last Name:POLIMAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 SUPERIOR AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4037
Mailing Address - Country:US
Mailing Address - Phone:219-934-6410
Mailing Address - Fax:219-934-6420
Practice Address - Street 1:701 SUPERIOR AVE
Practice Address - Street 2:SUITE L
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4037
Practice Address - Country:US
Practice Address - Phone:219-934-6410
Practice Address - Fax:219-934-6420
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33002719A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker