Provider Demographics
NPI:1952985780
Name:KIRK, EDEN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S DENTON TAP RD STE 270
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4094
Mailing Address - Country:US
Mailing Address - Phone:469-763-9459
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD STE 270
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4094
Practice Address - Country:US
Practice Address - Phone:469-763-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist