MEDICARE: MRS. JENNIFER ELISE EDWARDS LMSW

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	1041C0700X	Clinical Social Worker	6801093098	MI

General Provider Information

NPI Number	:	1659918597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ELISE EDWARDS LMSW

Provider Business Mailing Address
First Line	:	1110 ELDON BAKER DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-1923
Country	:	US
Telephone Number	:	810-213-1803
Fax Number	:

Provider Business Practice Location Address
First Line	:	3090 BEECHTREE LN
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-1941
Country	:	US
Telephone Number	:	810-223-3759
Fax Number	:

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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