Provider Demographics
NPI:1770245748
Name:EDWARDS, JESSIE MELISON
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MELISON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-1719
Mailing Address - Country:US
Mailing Address - Phone:970-355-9130
Mailing Address - Fax:
Practice Address - Street 1:211 GRAND AVE UNIT 114
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428-5093
Practice Address - Country:US
Practice Address - Phone:970-355-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker