Provider Demographics
NPI:1053521617
Name:TEDROW, EDWARD E (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:E
Last Name:TEDROW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BYRAM DR
Mailing Address - Street 2:APT 812
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9286
Mailing Address - Country:US
Mailing Address - Phone:604-372-5145
Mailing Address - Fax:
Practice Address - Street 1:2238 FIRST ST.
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-690-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical