MEDICARE: DEBORAH KAYE EDWARDS PLPC

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	101Y00000X	Counselor	178011822	IL
2	101YP2500X	Professional Counselor	178011822	IL
3	101YM0800X	Mental Health Counselor	178.011822	IL

General Provider Information

NPI Number	:	1366802514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KAYE EDWARDS PLPC

Provider Business Mailing Address
First Line	:	5016 N ILLINOIS ST
Second Line	:	SUITE A
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3411
Country	:	US
Telephone Number	:	618-398-7250
Fax Number	:	618-234-6311

Provider Business Practice Location Address
First Line	:	5016 N ILLINOIS ST
Second Line	:	SUITE A
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3411
Country	:	US
Telephone Number	:	618-398-7250
Fax Number	:	618-234-6311

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

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	11/13/2023

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