Provider Demographics
NPI:1538598529
Name:EDMUNDSON, ANDREW (LCAT, MT-BC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EDMUNDSON
Suffix:
Gender:M
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5004
Mailing Address - Country:US
Mailing Address - Phone:307-461-5825
Mailing Address - Fax:
Practice Address - Street 1:722 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5004
Practice Address - Country:US
Practice Address - Phone:307-461-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist