Provider Demographics
NPI:1932700523
Name:EDWARDS, JULIA ANN (NCSP, EIP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NCSP, EIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3808
Mailing Address - Country:US
Mailing Address - Phone:219-663-2173
Mailing Address - Fax:219-662-4378
Practice Address - Street 1:401 W JOLIET ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3808
Practice Address - Country:US
Practice Address - Phone:219-663-2173
Practice Address - Fax:219-662-4378
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10187049103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty