Provider Demographics
NPI:1770784159
Name:REGINA C. EDWARDS, MA CCC-SLP, PA
Entity type:Organization
Organization Name:REGINA C. EDWARDS, MA CCC-SLP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:828-768-4462
Mailing Address - Street 1:825-C MERRIMON AVE.
Mailing Address - Street 2:#395
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2402
Mailing Address - Country:US
Mailing Address - Phone:828-768-4462
Mailing Address - Fax:828-225-2761
Practice Address - Street 1:40 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3023
Practice Address - Country:US
Practice Address - Phone:828-768-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8300183K252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300183KMedicaid