Provider Demographics
NPI:1013284017
Name:EDENSHAW, ERIK
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:EDENSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MCKINLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1329
Mailing Address - Country:US
Mailing Address - Phone:907-306-6186
Mailing Address - Fax:
Practice Address - Street 1:615 BIDWILL AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7587
Practice Address - Country:US
Practice Address - Phone:907-452-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health