Provider Demographics
NPI:1831825132
Name:EDELEN, JEANNE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:EDELEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4136
Mailing Address - Country:US
Mailing Address - Phone:203-227-8299
Mailing Address - Fax:
Practice Address - Street 1:376 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3514
Practice Address - Country:US
Practice Address - Phone:401-274-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist