MEDICARE: DR. ANNE WYNNE EDENS PSY.D.

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	103TC0700X	Clinical Psychologist	1563	SC

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	:	1831217116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE WYNNE EDENS PSY.D.

Provider Business Mailing Address
First Line	:	2962 MEDICAL PLAZA DR.
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:	843-797-3637

Provider Business Practice Location Address
First Line	:	2962 MEDICAL PLAZA DR.
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:	843-797-3637

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	12/15/2021

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