Provider Demographics
NPI:1740051069
Name:EDWARDS, ALEXANDER (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:LONDYN
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:1227 ANZA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3941
Mailing Address - Country:US
Mailing Address - Phone:818-518-3417
Mailing Address - Fax:
Practice Address - Street 1:1650 LOS GAMOS DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1850
Practice Address - Country:US
Practice Address - Phone:415-444-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist