Healthcare Provider Details

I. General information

NPI: 1073688784
Provider Name (Legal Business Name): TAMARA SUE EDINGER LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 AIRPORT RD
JACKSON MI
49202-1872
US

IV. Provider business mailing address

PO BOX 271
JACKSON MI
49204-0271
US

V. Phone/Fax

Practice location:
  • Phone: 517-937-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801081945
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: