MEDICARE: JASMINE G. EDWARDS PH.D. & ASSOCIATES INC.

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	103T00000X	Psychologist	3793	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639290588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASMINE G. EDWARDS PH.D. & ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	1339 WOODMAN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-3425
Country	:	US
Telephone Number	:	937-253-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 WOODMAN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-3425
Country	:	US
Telephone Number	:	937-253-1987
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASMINE G. EDWARDS
Credential	:	PH.D.
Telephone Number	:	937-253-1987

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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