Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 000000 | KS |
NPI | 1215527254 |
---|---|
Provider Name | Mr. Wendell D Edwards II |
First Address | Kansas City, KS 66104-3743 |
Second Address | Kansas City, KS 66104-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2021 |
Last Update Date | 23/01/2021 |