Provider Demographics
NPI:1407163678
Name:EDWARDS-ADAMS, KEITA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KEITA
Middle Name:
Last Name:EDWARDS-ADAMS
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 1:3 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3109
Mailing Address - Country:US
Mailing Address - Phone:914-320-6683
Mailing Address - Fax:
Practice Address - Street 1:3 MERRITT AVE
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-3109
Practice Address - Country:US
Practice Address - Phone:914-320-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist