Provider Demographics
NPI:1558418954
Name:EDWARDS, ELLEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLEN
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 1:8301 ARLINGTON BLVD
Mailing Address - Street 2:T8
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2902
Mailing Address - Country:US
Mailing Address - Phone:703-904-8334
Mailing Address - Fax:703-904-8334
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:T8
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-904-8334
Practice Address - Fax:703-904-8334
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist