Provider Demographics
NPI:1346769254
Name:EDWARDS, JAIDE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIDE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BAKER ST APT 32
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9803
Mailing Address - Country:US
Mailing Address - Phone:315-237-2250
Mailing Address - Fax:
Practice Address - Street 1:100 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1242
Practice Address - Country:US
Practice Address - Phone:585-392-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025808-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist