Provider Demographics
NPI:1699159145
Name:KAVANAGH, EDIE
Entity type:Individual
Prefix:
First Name:EDIE
Middle Name:
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89306
Mailing Address - Street 2:VOLUNTEERS OF AMERICA - DAKOTAS
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6659
Mailing Address - Country:US
Mailing Address - Phone:605-367-4293
Mailing Address - Fax:605-367-5714
Practice Address - Street 1:908 N WEST AVE
Practice Address - Street 2:VOLUNTEERS OF AMERICA - DAKOTAS
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5722
Practice Address - Country:US
Practice Address - Phone:605-367-4293
Practice Address - Fax:605-367-5714
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator