Provider Demographics
NPI:1780812826
Name:EDWARDS, JUDY ANN (MSW, GSW, C-SSWS)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW, GSW, C-SSWS
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, GSW, C-SSWS
Mailing Address - Street 1:37123 KATHLEEN AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3465
Mailing Address - Country:US
Mailing Address - Phone:225-313-6552
Mailing Address - Fax:
Practice Address - Street 1:9880 HYACINTH AVE RM 9
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2433
Practice Address - Country:US
Practice Address - Phone:225-761-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2009-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67451041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6745OtherLOUISIANA STATE BOARD OF SOCIAL WORK EXAMINERS