Provider Demographics
NPI:1295280949
Name:EDWARDS, TANIA (AUDD)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AUDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N 140TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2439
Mailing Address - Country:US
Mailing Address - Phone:623-535-8770
Mailing Address - Fax:623-535-8771
Practice Address - Street 1:2700 N 140TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2439
Practice Address - Country:US
Practice Address - Phone:623-535-8770
Practice Address - Fax:623-535-8771
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist