Provider Demographics
NPI:1831268515
Name:EDWARDS-HENRY, CARMEN D (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:D
Last Name:EDWARDS-HENRY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 HIGHLANDS DRIVE
Mailing Address - Street 2:EAGLE POINT
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524
Mailing Address - Country:US
Mailing Address - Phone:575-714-0554
Mailing Address - Fax:
Practice Address - Street 1:1020 HIGHLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524
Practice Address - Country:US
Practice Address - Phone:575-714-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
NM3077235Z00000X
OR15326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist