Provider Demographics
NPI:1184897324
Name:ADAMS, REID EDWARD
Entity type:Individual
Prefix:MR
First Name:REID
Middle Name:EDWARD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:REID
Other - Middle Name:EDWARD
Other - Last Name:ADAMS-DENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:812 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6144
Mailing Address - Country:US
Mailing Address - Phone:559-627-3362
Mailing Address - Fax:559-627-3362
Practice Address - Street 1:812 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6144
Practice Address - Country:US
Practice Address - Phone:559-627-3362
Practice Address - Fax:559-627-3362
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 818231H00000X
CAHA 1899237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ43150ZOtherBLUE SHIELD OF CA
CAAU0008180Medicaid