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NPI Code Detail

MEDICARE: EDGEWOOD CLINICAL SERVICES, P.C.

MEDICARE: EDGEWOOD CLINICAL SERVICES, P.C.
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker149-010253IL
31041C0700XClinical Social Worker
42084B0040XBehavioral Neurology & Neuropsychiatry Physician
5363LP0808XPsychiatric/Mental Health Nurse Practitioner
6103T00000XPsychologist

General Provider Information

NPI Number : 1295914646
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDGEWOOD CLINICAL SERVICES, P.C.
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number : 480-524-0990
Fax Number :
Provider Business Practice Location Address
First Line : 2948 ARTESIAN RD STE 112
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-8559
Country : US
Telephone Number : 630-428-7890
Fax Number :
Authorized Official
Title or Position : CHIEF LEGAL OFFICER
Name : RYAN PARDO
Credential :
Telephone Number : 206-399-1493
Provider Enumeration Date : 11/01/2007
Last Update Date : 03/06/2024

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