Provider Demographics
NPI:1306803853
Name:EDWARDS, JENNIFER F (MSPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:F
Other - Last Name:SLIPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:130 MARVIN RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6100
Practice Address - Country:US
Practice Address - Phone:360-456-3300
Practice Address - Fax:360-456-6060
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA175069OtherDEPT OF LABOR & INDUSTRIE
WA5842EDOtherREGENCE BLUE SHIELD
WA8933595OtherCRIME VICTIMS
WA8372492Medicaid