Provider Demographics
NPI:1811389182
Name:EDENS-SZESZYCKI, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:EDENS-SZESZYCKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:EDENS-SZESZYCKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW/CRS
Mailing Address - Street 1:2105 N MERIDIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1491
Mailing Address - Country:US
Mailing Address - Phone:317-926-5463
Mailing Address - Fax:317-926-5498
Practice Address - Street 1:2105 N MERIDIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1491
Practice Address - Country:US
Practice Address - Phone:317-926-5463
Practice Address - Fax:317-956-5498
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1681-0-ASO175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist