Provider Demographics
NPI:1134432958
Name:EDWARDS, JENNIFER ROSEN (MS SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:VALERIE
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:1706 RIDGECREST DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4439
Mailing Address - Country:US
Mailing Address - Phone:602-361-4157
Mailing Address - Fax:
Practice Address - Street 1:1706 RIDGECREST DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4439
Practice Address - Country:US
Practice Address - Phone:602-361-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist