1780375493 NPI number — JONELLE EDWARDS CMHC-I

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780375493 NPI number — JONELLE EDWARDS CMHC-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
JONELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMHC-I
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:
1780375493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
278 E LESLIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SALT LAKE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84115-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-498-0125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 S RIO GRANDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84101-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-485-8051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2023

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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