Provider Demographics
NPI:1265770747
Name:EDWARDS, HOLLEY MINSHEW
Entity type:Individual
Prefix:MRS
First Name:HOLLEY
Middle Name:MINSHEW
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 BETHEA EXT
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-4014
Mailing Address - Country:US
Mailing Address - Phone:843-752-6132
Mailing Address - Fax:
Practice Address - Street 1:719 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2517
Practice Address - Country:US
Practice Address - Phone:843-423-1811
Practice Address - Fax:843-431-5021
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist