Provider Demographics
NPI:1578360038
Name:EDMONDS, ISAIAH CHRISTOPHER
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:CHRISTOPHER
Last Name:EDMONDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 24TH ST APT D12
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5758
Mailing Address - Country:US
Mailing Address - Phone:720-453-3500
Mailing Address - Fax:
Practice Address - Street 1:971 E WICHITA AVE
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2444
Practice Address - Country:US
Practice Address - Phone:785-377-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty