Provider Demographics
NPI:1457126070
Name:EDWARDS, JAMIE LYNN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BERGERON
Mailing Address - Street 1:712 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886-9786
Mailing Address - Country:US
Mailing Address - Phone:616-824-6826
Mailing Address - Fax:
Practice Address - Street 1:712 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:SIX LAKES
Practice Address - State:MI
Practice Address - Zip Code:48886-9786
Practice Address - Country:US
Practice Address - Phone:616-824-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst