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General NPI Number Information
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NPI Number | 1295159283
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Entity Type | Individual
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Provider Name | JAMIE EDWARDS LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 07/30/2023
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Provider Practice Location Address
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Address Line | 1701 E LAKE AVE STE 255
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City | GLENVIEW
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State | IL
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Zip | 60025-2037
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Country | US
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Telephone | 847-881-6870
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Fax |
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Provider Business Mailing Address
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Address Line | 9359 OSCEOLA AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-1127
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Country | US
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Telephone | 224-627-0534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149016269
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License Number State | IL
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