1063426153 NPI number — MS. ERICA DIANA EDWARDS BSW

Table of content: MS. ERICA DIANA EDWARDS BSW (NPI 1063426153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063426153 NPI number — MS. ERICA DIANA EDWARDS BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
ERICA
Provider Middle Name:
DIANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063426153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 OLIVE ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63103-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-729-4012
Provider Business Mailing Address Fax Number:
314-729-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 S KIRKWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-6195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-729-4004
Provider Business Practice Location Address Fax Number:
314-729-4002
Provider Enumeration Date:
07/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)