Jack Duane Edmondson, LCSW
Social Worker, Clinical in Poway, CA. Individual provider (NPI-1).
NPI number1093987166
StatusActive
Last updated in NPPESMar 29, 2008
Details
- NPI
- 1093987166
- Entity type
- Individual (NPI-1)
- Name
- Jack Duane Edmondson
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 29, 2008
- Last updated
- Mar 29, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 1903 | CA | Yes |
Practice location
14207 Kendra WayPoway, CA 92064-3330
Phone 858-748-7093
Mailing address
14207 Kendra WayPoway, CA 92064-3330
Phone 858-748-7093
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