Provider Demographics
NPI:1255992665
Name:EDENS, KATHLEEN GRAY (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GRAY
Last Name:EDENS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:EDENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:P. O. BOX 95
Mailing Address - Street 2:
Mailing Address - City:BECKVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75631
Mailing Address - Country:US
Mailing Address - Phone:903-754-1866
Mailing Address - Fax:
Practice Address - Street 1:2441 FM 124E
Practice Address - Street 2:
Practice Address - City:BECKVILLE
Practice Address - State:TX
Practice Address - Zip Code:75631
Practice Address - Country:US
Practice Address - Phone:903-754-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist