Provider Demographics
NPI:1205097128
Name:EDWARDS, TERRI JO (AUD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:JO
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLOW CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3652
Mailing Address - Country:US
Mailing Address - Phone:817-550-6115
Mailing Address - Fax:866-358-6404
Practice Address - Street 1:150 WILLOW CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-3652
Practice Address - Country:US
Practice Address - Phone:817-550-6115
Practice Address - Fax:866-358-6404
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51498237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280916203Medicaid