Organization
KENNETH EDWARDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH EDWARDS (THERAPIST)
(214) 662-1040
Entity
Organization
Contact information
Practice address
2133 W THOMAS ST, CHICAGO, IL 60622-3629
(214) 662-1060
Mailing address
2133 W THOMAS ST, CHICAGO, IL 60622-3629
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180010430
IL
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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