Provider Demographics
NPI:1649513383
Name:PERKIN, EDDWADO (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:EDDWADO
Middle Name:
Last Name:PERKIN
Suffix:
Gender:M
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7700
Mailing Address - Country:US
Mailing Address - Phone:773-640-8340
Mailing Address - Fax:
Practice Address - Street 1:1308 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7700
Practice Address - Country:US
Practice Address - Phone:773-640-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105956235Z00000X
TX462354190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty