Provider Demographics
NPI:1184916785
Name:EDWARDS, SARA JANE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748-9070
Mailing Address - Country:US
Mailing Address - Phone:309-275-2036
Mailing Address - Fax:
Practice Address - Street 1:108 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IL
Practice Address - Zip Code:61748-9070
Practice Address - Country:US
Practice Address - Phone:309-275-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist