Provider Demographics
NPI:1821467135
Name:EDWARDS, EMILY (MS SLP INTERN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-6099
Mailing Address - Country:US
Mailing Address - Phone:806-281-6232
Mailing Address - Fax:806-281-6233
Practice Address - Street 1:1717 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-6099
Practice Address - Country:US
Practice Address - Phone:806-281-6232
Practice Address - Fax:806-281-6233
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist