Provider Demographics
NPI:1649360744
Name:EDWARDS, GAYLE ELAINE (LSCSW)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:ELAINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MRS
Other - First Name:GAYLE
Other - Middle Name:ELAINE
Other - Last Name:STEGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:423 HOUSTON STREET
Mailing Address - Street 2:
Mailing Address - City:MANHATRAN
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4271
Mailing Address - Country:US
Mailing Address - Phone:785-587-4345
Mailing Address - Fax:
Practice Address - Street 1:423 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6169
Practice Address - Country:US
Practice Address - Phone:785-547-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS#068547Medicare UPIN