Provider Demographics
NPI:1679629182
Name:EDGAR, DEBRA LYNN (EDD CCC SLP)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:EDGAR
Suffix:
Gender:F
Credentials:EDD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2834 FITZOOTH DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4817
Mailing Address - Country:US
Mailing Address - Phone:407-249-4770
Mailing Address - Fax:407-249-4774
Practice Address - Street 1:12424 RESEARCH PKWY
Practice Address - Street 2:SUITE 155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3249
Practice Address - Country:US
Practice Address - Phone:407-249-4770
Practice Address - Fax:407-249-4774
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist