Provider Demographics
NPI:1700223625
Name:EDMONDS, LAURA JEAN (LICENSED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:LICENSED
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:DALESSIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED
Mailing Address - Street 1:1801 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3028
Mailing Address - Country:US
Mailing Address - Phone:661-632-1860
Mailing Address - Fax:
Practice Address - Street 1:1801 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3028
Practice Address - Country:US
Practice Address - Phone:661-733-2130
Practice Address - Fax:661-632-1861
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA882231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker