Doctor Name: | AMBER L EDWARDS |
NPI Number: | 1740487792 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 22004192A |
Business Practice Address: | 6040 Lute Rd Portage, IN - 463685008 |
Business Phone Number: | 2197636858 |
Business Fax Number: | 2197636858 |
Mailing Address: | 11963 Cassandra Ln, WESTVILLE |
State: | IN |
Postal Code: | 46391 |
Phone Number: | 2197850004 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22004192A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |