Provider Demographics
NPI:1467569467
Name:EDWARDS, KATHLEEN ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
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 1:4202 HERMITAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3755
Mailing Address - Country:US
Mailing Address - Phone:804-266-6699
Mailing Address - Fax:804-264-5988
Practice Address - Street 1:SCOTTISH RITE CHILDHOOD LANGUAGE CENTER
Practice Address - Street 2:4202 HERMITAGE ROAD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3755
Practice Address - Country:US
Practice Address - Phone:804-266-6699
Practice Address - Fax:804-264-5988
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195246OtherBCBS
VA259332OtherSOUTHERN HEALTH
VA3822946OtherCIGNA PPO
VA255800OtherALLIANCE NETWORK
VA49-7877-3Medicaid
VI11123OtherCARENET
VA49-7877-3Medicaid