Provider Demographics
NPI:1023424157
Name:EDWARDS, TANNER MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 HARRISON ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3708
Mailing Address - Country:US
Mailing Address - Phone:785-917-0609
Mailing Address - Fax:
Practice Address - Street 1:1211 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2129
Practice Address - Country:US
Practice Address - Phone:913-890-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS92341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical