Provider Demographics
NPI:1457492431
Name:KHANEDRA Z EDWARDS
Entity Type:Organization
Organization Name:KHANEDRA Z EDWARDS
Other - Org Name:SIMPLY SPEAKING
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KHANEDRA
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:219-331-9514
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-0812
Mailing Address - Country:US
Mailing Address - Phone:219-331-9514
Mailing Address - Fax:219-939-0020
Practice Address - Street 1:760 N RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2257
Practice Address - Country:US
Practice Address - Phone:219-331-9514
Practice Address - Fax:219-939-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003661A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200726320Medicaid
IN200673060Medicaid