Provider Demographics
NPI:1013291343
Name:EDWARDS-WOLCOTT, BREA (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BREA
Middle Name:
Last Name:EDWARDS-WOLCOTT
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:12758-5004
Mailing Address - Country:US
Mailing Address - Phone:845-439-4400
Mailing Address - Fax:845-439-4717
Practice Address - Street 1:19 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-5004
Practice Address - Country:US
Practice Address - Phone:845-439-4400
Practice Address - Fax:845-439-4717
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016172-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist