Provider Demographics
NPI:1366329096
Name:EDWARDS, JENNIFER SUE (CRT / RPSGT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CRT / RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SW GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8405
Mailing Address - Country:US
Mailing Address - Phone:816-682-5631
Mailing Address - Fax:
Practice Address - Street 1:809 SW GRAYSTONE DR
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8405
Practice Address - Country:US
Practice Address - Phone:816-682-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000155692227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified