Provider Demographics
NPI:1851735989
Name:FELIX, EDITH (SLP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:FELIX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5841
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2490
Mailing Address - Country:US
Mailing Address - Phone:928-722-6050
Mailing Address - Fax:928-722-6094
Practice Address - Street 1:1233 N MAIN STREET
Practice Address - Street 2:STE 10 11 & 12
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-722-6050
Practice Address - Fax:928-722-6094
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTSLP7061OtherAZ LICENSE