Provider Demographics
NPI:1922122787
Name:EDEL, JERE AGNES (SLP)
Entity Type:Individual
Prefix:MS
First Name:JERE
Middle Name:AGNES
Last Name:EDEL
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 785
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-0785
Mailing Address - Country:US
Mailing Address - Phone:814-837-6706
Mailing Address - Fax:814-837-9205
Practice Address - Street 1:100 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-9704
Practice Address - Country:US
Practice Address - Phone:814-837-6706
Practice Address - Fax:814-837-9205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004374L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist