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NPI Code Detail

MEDICARE: JUSTIN L EDENS

MEDICARE: JUSTIN L EDENS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1518808005
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN L EDENS
Provider Business Mailing Address
First Line : 3462 E NAOMI AVE
Second Line :
City : WASILLA
State : AK
Zip : 99654-7452
Country : US
Telephone Number : 907-745-6200
Fax Number : 907-215-3343
Provider Business Practice Location Address
First Line : 7335 E PALMER WASILLA HWY
Second Line :
City : PALMER
State : AK
Zip : 99645-7710
Country : US
Telephone Number : 907-745-6200
Fax Number : 907-215-3343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2026
Last Update Date : 04/01/2026

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Directions to “ JUSTIN L EDENS ” Practice Location

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