Provider Demographics
NPI:1902850712
Name:EDWARDS, REGINA CAROL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:CAROL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825-C MERRIMON AVE.
Mailing Address - Street 2:#395
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:828-768-4462
Mailing Address - Fax:
Practice Address - Street 1:40 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3023
Practice Address - Country:US
Practice Address - Phone:828-768-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411753Medicaid
NC130P8OtherBCBS PROVIDER NUMBER