Provider Demographics
NPI:1811502230
Name:EDWARDS, SUSAN J (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13627 VASILI DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-6708
Mailing Address - Country:US
Mailing Address - Phone:907-854-3093
Mailing Address - Fax:
Practice Address - Street 1:6927 OLD SEWARD HWY STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2284
Practice Address - Country:US
Practice Address - Phone:907-268-0043
Practice Address - Fax:907-677-0844
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health