Provider Demographics
NPI:1720051766
Name:EDWARDS, INGRID (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2793
Mailing Address - Country:US
Mailing Address - Phone:502-515-3320
Mailing Address - Fax:502-515-3325
Practice Address - Street 1:117 E KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2793
Practice Address - Country:US
Practice Address - Phone:502-584-3573
Practice Address - Fax:502-583-6364
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0312231H00000X
KY0727237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200142970Medicaid
KY640004489OtherRAILROAD MEDICARE
KY000000233795OtherANTHEM
KY70000906Medicaid