Provider Demographics
NPI:1720095698
Name:ADAMS, EDWARD THOMAS JR (SLP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:THOMAS
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 E. JULIUS STRAVENUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3709
Mailing Address - Country:US
Mailing Address - Phone:520-270-4816
Mailing Address - Fax:520-207-2632
Practice Address - Street 1:5656 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2210
Practice Address - Country:US
Practice Address - Phone:520-885-9567
Practice Address - Fax:520-885-9568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist