Provider Demographics
NPI:1487924171
Name:EDWARDS, CHAD ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ROBERT
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6514
Mailing Address - Country:US
Mailing Address - Phone:574-855-7169
Mailing Address - Fax:
Practice Address - Street 1:314 W CATALPA DR
Practice Address - Street 2:SUITE E
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3194
Practice Address - Country:US
Practice Address - Phone:574-254-1700
Practice Address - Fax:574-254-2930
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042553A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist