Provider Demographics
NPI:1700086915
Name:EDWARDS, ALLISON J (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:EDWARDS
Other - Last Name:HUDSON-EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:508 N. 24TH ST.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2611
Mailing Address - Country:US
Mailing Address - Phone:719-964-4275
Mailing Address - Fax:719-344-2271
Practice Address - Street 1:508 N. 24TH ST.
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2611
Practice Address - Country:US
Practice Address - Phone:719-964-4275
Practice Address - Fax:719-344-2271
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55889093Medicaid
NM11639067Medicaid