MEDICARE: DR. JORIE H EDWARDS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	01012	IA

General Provider Information

NPI Number	:	1477699536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORIE H EDWARDS PH.D.

Provider Business Mailing Address
First Line	:	3408 WOODLAND AVE
Second Line	:	SUITE 209
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-225-2015
Fax Number	:	515-225-1744

Provider Business Practice Location Address
First Line	:	3408 WOODLAND AVE
Second Line	:	SUITE 209
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-225-2015
Fax Number	:	515-225-1744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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