MEDICARE: ABIGAIL NEDVED MA, QMHP

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891336731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL NEDVED MA, QMHP

Provider Business Mailing Address
First Line	:	325 M ST
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-1023
Country	:	US
Telephone Number	:	712-358-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 EXECUTIVE DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1345
Country	:	US
Telephone Number	:	618-688-4782
Fax Number	:

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

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	10/02/2019

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