1467569467 NPI number — KATHLEEN ANN EDWARDS M.S., CCC-SLP

Table of content: KATHLEEN ANN EDWARDS M.S., CCC-SLP (NPI 1467569467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467569467 NPI number — KATHLEEN ANN EDWARDS M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
KATHLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467569467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4202 HERMITAGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23227-3755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-266-6699
Provider Business Mailing Address Fax Number:
804-264-5988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SCOTTISH RITE CHILDHOOD LANGUAGE CENTER
Provider Second Line Business Practice Location Address:
4202 HERMITAGE ROAD
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23227-3755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-266-6699
Provider Business Practice Location Address Fax Number:
804-264-5988
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202001611 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 195246 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 259332 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3822946 . This is a "CIGNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 255800 . This is a "ALLIANCE NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 49-7877-3 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11123 . This is a "CARENET" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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