Provider Demographics
NPI:1134926314
Name:EDWARDSON, TRICIA
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:EDWARDSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2488
Mailing Address - Country:US
Mailing Address - Phone:308-227-1006
Mailing Address - Fax:
Practice Address - Street 1:3623 W 18TH ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2488
Practice Address - Country:US
Practice Address - Phone:308-227-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician