Provider Demographics
NPI:1760296602
Name:EDWARDS, MENA
Entity type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:EDWARDS
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 1:809 BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8615
Mailing Address - Country:US
Mailing Address - Phone:815-690-7571
Mailing Address - Fax:
Practice Address - Street 1:611 W JEFFERSON ST STE 201
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-3772
Practice Address - Country:US
Practice Address - Phone:630-281-2496
Practice Address - Fax:630-839-9138
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor