Provider Demographics
NPI:1396477089
Name:EDWARDS-UGIOMOH, RUDESTA (MSW, LSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:RUDESTA
Middle Name:
Last Name:EDWARDS-UGIOMOH
Suffix:
Gender:F
Credentials:MSW, LSW, LSWAIC
Other - Prefix:
Other - First Name:RUDESTA
Other - Middle Name:C
Other - Last Name:EDWARDS-UGIOMOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 N HOWARD ST STE W
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:614-962-2121
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE W
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:614-962-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2105826104100000X
WASC616157301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1396477089Medicaid