Healthcare Provider Details

I. General information

NPI: 1578846432
Provider Name (Legal Business Name): MINDY ANN EDWARDS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FREEDOM DR
NAPOLEON OH
43545-9038
US

IV. Provider business mailing address

15840 CAMPBELL RD
DEFIANCE OH
43512-8833
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-1660
  • Fax: 419-592-8336
Mailing address:
  • Phone: 419-393-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0700032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: