MEDICARE: JENNIFER EDMONDSON LPC

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	101YP2500X	Professional Counselor	2009010544	MO

General Provider Information

NPI Number	:	1699185124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER EDMONDSON LPC

Provider Business Mailing Address
First Line	:	721 ZEISS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1421
Country	:	US
Telephone Number	:	314-401-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 ZEISS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1421
Country	:	US
Telephone Number	:	314-401-5581
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	09/11/2015

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