Provider Demographics
NPI:1972944858
Name:EDWARDS, KEISHA (MA, SLPD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, SLPD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3929
Mailing Address - Country:US
Mailing Address - Phone:908-397-4373
Mailing Address - Fax:732-694-6701
Practice Address - Street 1:29 TERRY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3929
Practice Address - Country:US
Practice Address - Phone:908-397-4373
Practice Address - Fax:732-694-6701
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00381400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist