Provider Demographics
NPI:1528233673
Name:EDMAN, SALLY QUINCENT OAKES (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:QUINCENT OAKES
Last Name:EDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 8TH ST SW
Mailing Address - Street 2:WELLNESS CENTER
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52101
Mailing Address - Country:US
Mailing Address - Phone:712-707-7321
Mailing Address - Fax:
Practice Address - Street 1:208 8TH ST SW
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:52101
Practice Address - Country:US
Practice Address - Phone:712-707-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00598103TC0700X
IA598103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth