Provider Demographics
NPI:1477396604
Name:EDWARDS, JEAN (MS)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MATHEWS DR APT 209
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3636
Mailing Address - Country:US
Mailing Address - Phone:802-376-4567
Mailing Address - Fax:
Practice Address - Street 1:96 MATHEWS DR APT 209
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3636
Practice Address - Country:US
Practice Address - Phone:802-376-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency